Please note that you will be asked to state on this form the remediation plan that you worked out with yourcourse/clerkship site director. Please do that before you complete this form.
You selected the NBME exam. Even though it is technically a component of a clerkship, you should discuss thisabsence with Dr. Sperling (email@example.com, 330.325.6778) and let the test administrator know as well(Lisa Morris: firstname.lastname@example.org, 330.325.6334). You do not need to fill out a separate absence notificationfor the clerkship.