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Elective Absence Form

Elective Absence Form

For interviews during a 4th year elective, please notify us by completing this form at least 2 weeks prior to your expected leave date. Earlier notice is preferred if possible.

The information you provide will be distributed to the elective coordinator, your elective director and/or faculty as applicable. It is imperative that you complete this form in a timely manner. Failure to do so could result in a professionalism issue to be discussed by the Student Promotions Committee (SPC). You will receive an approval or denial from your respective elective coordinator after submitting this form. Academic Affairs will provide approval for absences related to local or national meetings and/or conferences.

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

You must provide all requested information. All information is subject to an independent review and confirmation process.

This policy is described in the section "Attendance and Absenteeism Policies" in the Student Handbook  for School of Medicine Students.

Here is the direct Qualtrics link for the elective absences: