Student Absence Request

Refer to the current approved Academic Calendar to confirm dates and impacted courses.
 
College of Medicine-Phoenix Attendance and Absence Policies to reference:
Years 1 & 2
Years 3 & 4
 
If requesting an absence from multiple blocks/courses/clerkships/electives, you must receive approval from EACH impacted block/course/clerkship/elective for your absence to be fully approved (unless a single approval is given from the Office of Student Affairs).
 

Student Info

What MD class are you currently a part of? *

Pre-Clerkship Absence Request

Standard - Most common request for absence, such as minor illness, personal family event, conference presentation, etc. Please describe the absence request in the box on this form, and your request will be forwarded to the block/course/clerkship director for consideration.

Religious Accommodation - Absence for the purpose of religious practice or belief, in accordance with the University of Arizona Religious Accommodation Policy. Your request will be forwarded only to the Associate Dean of Student Affairs.

Personal / Sensitive Nature - Absence due to a personal and/or especially sensitive issue you wish to discuss confidentially with the Associate Dean of Student Affairs. Your request will be forwarded only to the Associate Dean of Student Affairs. You should then make contact with the Associate Dean to discuss the issue. You do not need to describe the issue in detail on this form.
Type of Absence Request *
Do you wish to engage remotely if an option is available?
Select one
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Close contact is defined by the CDC as being within 6 feet of a person with confirmed COVID-19 for a minimum of 15 consecutive or cumulative minutes over a 24 hour period. This does not include exposures in which the affected person is consistently wearing a mask, nor does it include clinical encounters in which proper PPE and precautions are utilized. If you have received your COVID-19 booster, you do not need to quarantine. Please include the date(s) of close contact. You do not need to provide personal details. Please refer to the CDC guideline below and consider testing on day 5. If you develop symptoms, get a test and stay home.

If You Were Exposed* to Someone with COVID-19 (Quarantine)

If you:

Have been boosted
OR
Completed the primary series of Pfizer or Moderna vaccine within the last 6 months
OR
Completed the primary series of J&J vaccine within the last 2 months

·         Wear a mask around others for 10 days.

·         Test on day 5, if possible.

If you develop symptoms get a test and stay home.

If you:

Completed the primary series of Pfizer or Moderna vaccine over 6 months ago and are not boosted
OR
Completed the primary series of J&J over 2 months ago and are not boosted
OR
Are unvaccinated

·         Stay home for 5 days. After that continue to wear a mask around others for 5 additional days.

·         If you can’t quarantine you must wear a mask for 10 days.

·         Test on day 5 if possible.

If you develop symptoms get a test and stay home

If you develop symptoms, please get tested and stay home. You may return to campus or clinical activities upon receiving a negative test and improvement of symptoms. If you receive a positive test, please resubmit an absence request for the appropriate duration of isolation. You do not need to provide a description of symptoms or personal details below. If you have questions or are uncertain about whether you may return to campus/clinical activities, please call Campus Health at 520-621-9202.

Absence Request

Absence Request Type *
Check the box corresponding to each of the following statements indicating your attestation in accordance with the University of Arizona College of Medicine’s Honor Code.
My absence meets one of the following reasons.
  • Presentation at a professional conference or leadership activity
  • Religious observance
  • Personal circumstances
  • Personal wellness 
  • Residency interviews and application-related activities
 *
My cumulative absences for this curricular unit will not exceed an average of 0.5 days per week of rotation (i.e. I will not exceed 2 days of absence in a 4 week rotation) *
I will not miss ANY mandatory synchronous sessions during PPDA, including LPC activities. If any required PPD sessions will be missed, a personal absence request must be submitted to ensure an absence does not result in subsequent changes to your scheduled clerkship(s). *

My absence request meets timeliness requirements as outlined in the Years 3 and 4 Attendance and Absence policy for one of the following reasons:

  • I am submitting this absence request more than 30 days in advance of my absence.
  • I am submitting this absence request with less than 30 days notice as this was the earliest opportunity due to reasons outside of my control (i.e. acute illness, personal emergency, residency interview invite with short notice).
 *
I understand that this absence request will be automatically approved in accordance with the Honor Code. Inaccurate representation on the form itself or during my communication with curricular faculty would represent a failure to meet professionalism and trustworthiness expectations as outlined in the Educational Program Objectives and would be considered a violation of the Honor Code policy. Dishonesty on this form may affect student assessment and result in an Honor Code violation. *
I have notified my course director, site director, and clinical team of my absence (attending or senior resident I am working with, as applicable), and I will work with them to complete an absence remediation plan.

Absence Dates

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Exams

Will you be missing an exam? *
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Impacted Curriculum

Pathway *
First Year *
Second Year *
Doctoring Attestation: *
Select your assigned Doctoring day. *
Select which session in Doctoring you will be absent for: *
Select which session in Doctoring you will be absent for: *
Third Year *
PPDA: Clerkship *
PPDA: Modality *
Fourth Year *
Makeups taking place during Capstone's weeks must also be communicated to the Capstones team (by the student) within 48 hours of your Doctoring absence to avoid conflict. Doctoring makeup sessions typically run from 1-5pm and will cover all content and SP encounters missed.

Reason for Absence


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