Medical Student Absence Request Form

For questions about the attendance procedures and absence form, Hershey students should email medstudentabsence@pennstatehealth.psu.edu. University Park students should email UP-COM@pennstatehealth.psu.edu.
Student Information











Phase I Absence Information





Please note that general absences require:
  • 7 working days notice
  • You to notify your small-group facilitator or student group member
No explanation is necessary
Please note that religious observance absences require:
  • 7 working days notice
  • You to notify your small-group facilitator or student group member
  • Religious absences are usually allowed for only a single day at a time. For travel to and from a religious celebration, submit a “general absence” request. You may also use this field to describe an ongoing, i.e. weekly, observance that we should accommodate in your schedule.” Other than that, no explanation of religious observance is required. 
Please note that absences related to military obligations require:
  • 7 working days notice
  • You to notify your small-group facilitator or student group member
  • An explanation (input below)
If you are "applying for an exception," please address the exception in the comments field. 

Phase II Absence Information








Please note that unexpected absences require:
  • You must submit this form the morning of your absence. For emergencies, contact Medical Education at 717-531-8563 within 24 hours of absence.
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that religious observance absences require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that absences related to military obligations require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that absences related to presentations at conferences require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that absences related to medical appointments require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that personal event absences require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
  • If Student Health has placed you on quarantine, please notify your course/clerkship director to make them aware of the length of your absence. 
Please note that weather-related absences require:
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that educational activity absences require:
  • You to notify your Kienle Group preceptors
  • An explanation (input below)

Phase III Absence Information







Please note that unexpected absences require:
  • You must submit this form the morning of your absence. For emergencies, contact Medical Education at 717-531-8563 within 24 hours of absence.
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that religious observance absences require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that absences related to military obligations require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that absences related to presentations at conferences require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that absences related to medical appointments require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that personal event absences require:
  • 4 weeks notice
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)
Please note that personal event absences require:
  • 4 weeks notice
  • You to notify your course director and coordinator within 24 hours of scheduling the interview
  • You to notify your Phase III preceptor or team
  • An explanation (input below)
  • If Student Health has placed you on quarantine, please notify your course/clerkship director to make them aware of the length of your absence. 
Please note that weather-related absences require:
  • You to notify your Phase II/III preceptor or team
  • An explanation (input below)

Policy/Confirmation
Click to read the complete attendance policy for Phase I or Phase II and III. An email of approval be sent to you after this form is received and any necessary approvals have been completed.

Contact Information