PLEASE READ: This form is required for students who are missing school/clinic due to unexpected circumstances. If you are missing clinic, this form is to be filled out AFTER you have notified your patient coordinator of your absence. This form is not a replacement for notifying your patient coordinator. Unplanned absences DO count toward leave days for 3DN and 4DN students. Documentation is required (e.g. doctor’s note) to excuse the absence, per the student handbook.