Absence Notification Form - Fourth Year Medicine

AY 2019-20

Enter the following information:

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

Have you contacted your elective/course 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
elective/course director. Please do that before you complete this form.

What course or activity is affected by this absence?

Northeast Ohio Medical University