Absence Notification Form - Third Year Medicine

AY 2018-19

Enter the following information:

Before you submit an absence notification form you must already have
made arrangements with your course/clerkship site director on your make-up plan.

Have you contacted your course/clerkship site director and arrived at a plan for making up time and any
required activities missed during absence?

Please note that you will be asked to state on this form the remediation plan that you worked out with your
course/clerkship site director. Please do that before you complete this form.

What course or activity is affected by this absence?

If the absence results in you missing a required activity in more than one course, you must submit a separate
absence report for each course.

You selected the NBME exam. Even though it is technically a component of a clerkship, you should discuss this
absence with Dr. Sperling (dsperling@neomed.edu, 330.325.6778) and let the test administrator know as well
(Lisa Morris: lmorris@neomed.edu, 330.325.6334). You do not need to fill out a separate absence notification
for the clerkship.

Northeast Ohio Medical University