SCPE Exigent Circumstances Form
If an unforeseen event occurs that affects a student's ability to adhere to the attendance policy, this form must be submitted to the Clinical Committee. Examples of such events include, but are not limited to, serious illness, injury, natural disasters, or the death of an immediate family member. The request will be reviewed and recommendations will be made by the Clinical Committee.
Student Name
*
First Name
Last Name
Student Email
example@example.com
Date(s) of Absence
SCPE Rotation(s) Affected
R1
R2
R3
R4
R5
R6
R7
R8
Explanation of Circumstances
Supporting Documentation
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