Time Off Request Form

Students are personally responsible for attending and arriving on time to all required educational activities as specified by the block, course, or clerkship directors. All students are required to notify the Office of Student Affairs of any planned or unexpected absences via the Time Off Request Form below. For planned absences, students are required to complete this form as far in advance as possible. For unexpected absences, students should notify their course/clerkship directors as soon as possible in addition to completing the Time Off Request Form below. For more information on our attendance policy, please click here. Requests for time off for religious holidays must be submitted in accordance to the NSU University-Wide Religious Holidays Policy.

Please complete this form in its entirety. Once your request has been reviewed by the Office of Student Affairs, you will be notified via your NSU email of the final decision and any additional actions required.

Request Information

Year: *

First Name:

Last Name:

Student N#:

NSU Email:

Student Phone:

Time Off Requested:

Day(s)/Hour(s) Requested:

Type of Absence Request: *

Planned

Unexpected

Planned Absence:

Attach a file for the planned absence:

Unexpected Absence:

Attach a file for the unexpected absence:

Please provide a detailed description of your absence request, including specific dates, and indicate what measures you have taken or plan to take to minimize impacts of your absence:

Please indicate what required educational activities you will miss and include name(s) of your course/clerkship director(s):

Please verify that you have completed all required fields and are not a robot before submitting this form.