CoD EXCUSED ABSENCE
Questions marked with a * are required
100%
UTHSC College of Dentistry Request Form for Excused Absence; 2019
This form MUST be used to request an excused absence in the College of Dentistry (CoD). Responses from this form will automatically be sent to Dr. Mark Scarbecz (mscarbecz@uthsc.edu), Associate Dean, CoD, for approval.

IMPORTANT POINTS
  • Except in cases of emergency, requests MUST be submitted BEFORE the expected absence date
  • Questions preceded with a * MUST be completed
  • Documentation to accompany your excused absence should be submitted separately as an attachment in an email. (mscarbecz@uthsc.edu)
  • Please be sure to click DONE to ensure responses are recorded.
  • You may be asked to provide additional documentation.
  • Absence is NOT officially approved until you receive email confirmation from Dr. Scarbecz
*Your FULL (legal) name:
*Year in the DDS or DH Program
Email Address
First date of excused absence
Last date of excused absence (REQUIRED if more than one day)
Below, list ALL the days, courses AND course directors for the days you will be missing (in chronological order).
IF D3/D4 the names of ALL your Group Leaders MUST be included
EXAMPLE: 9/1/2019,Pathobiology, Stein

 
*List ALL the days, courses AND course directors for the days you will be missing (in chronological order).
If D3/D4 the names of ALL your Group Leaders MUST be included.
*Reason for requesting an excused absence: (* = DOCUMENTATION REQUIRED; # = EXPLANATION REQUIRED)
Please provide additional information to support your request. (REQUIRED when option with # selected above)
ADDITIONAL DOCUMENTATION: This system does NOT support additional documentation. If you have additional documentation, please email it separately to Dr. Scarbecz: mscarbecz@uthsc.edu
PLEASE INCLUDE IN THE SUBJECT LINE: YOUR FULL NAME; YEAR IN THE PROGRAM, AND THE DATE ON WHICH YOU COMPLETED THE EXCUSED ABSENCE REQUEST
PLEASE CLICK DONE TO ENSURE THAT YOUR ANSWERS ARE RECORDED. 
YOUR ABSENCE IS NOT OFFICIALLY EXCUSED UNTIL YOU RECEIVE APPROVAL FROM DR. SCARBECZ