Elective Absence Form

For interviews during a fourth-year elective, notify us by completing this form two weeks or more prior to your expected leave date.

For absences, you will receive an approval or denial from Academic Affairs after completing this form.

The information you provide will be distributed to the elective coordinator, your student affairs coordinator, elective director and faculty as applicable. It is imperative that you complete this form promptly. Failure to do so could result in a professionalism issue to be discussed by the Student Promotions Committee (SPC).

However, in emergent situations (i.e. less than 24 hours notice) you need to contact your respective faculty, the elective coordinator, and complete this form as soon as possible.

For more information regarding absences and attendance, see the "Attendance and Absenteeism Policies" section in the Student Handbook for School of Medicine students. For informational purposes, students may also choose to utilize the absence request form process flow chart.