Absence Request Form

Name: (*As it appears on Name Badge) Class Year: ____ CPT # ____
Absence dates: ___________________________________ Number of Days:

Absence Category: _____ Student Leave _____ University Related Activity (URA)
Leave Approval: Appropriate Course director and/or CPT Leader signature. (Students must
obtain appropriate signatures for all missed courses and clinical work.)

Signature(s): _________________ __________________

University Related Activity Approval: Appropriate Dean or Director must approve URA.
Reason:_______________________________

Signature(s): _________________ __________________

Attendance Policy:
Roseman University of Health Sciences College of Dental Medicine expects students to attend all lectures,
simulation clinic sessions, and patient care clinic activities. Students have a responsibility to prepare for patient
care in didactic courses and simulation clinic sessions. Additionally, students have an obligation to their fellow
students and patients to attend all patient care clinic activities. While the attendance policy has been outlined,
individual course director(s) may adapt the policy to suit the needs of their particular curriculum component. If a
student is absent to the extent that his/her coursework or patient care is adversely affected, the course instructor
or CPT leader will notify the student and Chair of the Academic Performance and Standards Committee.
Attendance is reviewed each academic reporting period.

1. Students have 15 leave days per academic year. Days do not carry over from one year to the next.

a. Leave exceeding 15 days during the didactic course of study (D1 or D2 years) will necessitate attendance
during summer remediation. As this is a team-based educational model, teamwork skills will be assessed
during this remediation period.

b. Leave exceeding 15 days during the clinical course of study (D3 or D4 years) will necessitate attendance
beyond graduation so that competency can be assessed, mentoring of less experienced student partners
can take place, and continuity of patient care is assured.

2. Absence Category

a. Leave:
i. Student illness, personal or family emergency, bereavement, specialty externships, personal day
b. University Related Activities – URA
i. Approved attendance at professional meetings, community rotations, community service, board &
licensure examinations, mentoring electives

*Situations may arise as exceptions to this policy and will be handled at the discretion of the course directors, CPT
leader, and Associate Deans