Early Assessment Request

Early Assessment Request

This form is designed for enrolled didactic PA students to request an early assessment due to a known, planned absence.Important: All requests must be submitted before the end of the first week of classes for the semester in which the assessment occurs. Submitting this form initiates a two-tier review process, evaluating both the compelling nature of your request and the logistical feasibility for the specific course. Please remember that an approved early assessment does not exempt you from standard program attendance expectations; you must still complete the official Student Attendance Form for your missed class time.
🛑 STOP BEFORE YOU PROCEED 🛑

Do not use this form if you have an EXCUSED absence (e.g., sudden illness, medical emergency, bereavement). Students with approved excused absences will follow standard program policy to make up the assessment after the cohort takes it.

This form is strictly for PLANNED, UNEXCUSED absences. If you are choosing to miss a scheduled assessment for a personal reason (e.g., a wedding, family event, or personal travel), you must use this form to request permission to take the assessment early.
Student Information
Student Name

First NameLast Name
Student Email
example@example.com
L#
Absence & Justification Details
What type of absence are you reporting today?
Action Required: Based on your selection, this form is not appropriate for your situation. Per program standards, excused absences are eligible for post-assessment make-ups. Please exit this form, submit your official Didactic Attendance Form with the appropriate documentation, and coordinate your make-up assessment directly with your Course Director or Block Instructor.
Is this a multi-day absence?
Planned Absence Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Planned Absence End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Compelling Reason for Request
Provide a DETAILED narrative explaining why you are requesting to take this assessment early.
Supporting Documentation

Attach any relevant documentation that supports your compelling reason.
Cancelof
Assessment Details
Course # / Course Name
Course Director / Block Instructor
Select the faculty member directly responsible for administering this specific assessment.
Instructor Routing Email
example@example.com
Adjunct Name

First NameLast Name
Adjunct Email
ex. first.lastname@lipscomb.edu
Date of Original Assessment

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of Assessment

Other
Acknowledgements
Signature
Should be Empty:

Early Assessment Request

Student Information

Absence & Justification Details

Assessment Details

Acknowledgements