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Absence from OT Program Activity Form

This form is required of all students missing any required program activity and must be
submitted to each Course/Activity Director for all absences.


Refer to the OT Program Student and Student Fieldwork Handbooks for the Program’s absence policies, including consequences for repetitive requests and unexcused absences.


If on a Supervised Clinical Practice Experience, students must inform and make arrangements
with their Clinical Preceptor for all missed activities and indicate that arrangement on this form.

All fields marked with asterisk (*) are required.

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Have you contacted the Course Director(s) or Clinical Instructor regarding this possible absence?*
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I have reread the OT Program’s absence policies as published in the OT Program Student Handbook for the applicable year of my program.*
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I understand that submitting this form in no way guarantees that the absence will be approved and excused.*
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I understand that this absence will count as an unexcused absence unless approved by the Course Director, and, as such, falls under the OT Program’s professionalism policies.*
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I understand that I may be responsible for making up any absences after hours, at the discretion of the course/activity director, and will be held to the standards that have been set forth in the Program’s Student Handbook and Student Clinical Handbook.*