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Academic (Absence) Notification Form

The Office Student Outreach & Support assists students who are unable to attend class due to an extenuating circumstances by sending formal notifications to instructors and other appropriate University officials. Please utilize this form to make such requests. Note: Formal documentation is required for verification purposes.

Example of acceptable documentation:

-Bereavement/Death: Documentation should include a death certificate, obituary, memorial service pamphlet, or other item that identifies the student as related to the deceased. Documentation should include dates of treatment and anticipated return date (if known).

-Physical or Mental Health: Documentation must be provided on official letterhead, signed and dated by a licensed medical or mental health provider. Documentation should include the dates of treatment and student's anticipated return date.
*Please note that COVID-19 test results must be from a licensed medical provider (e.g. Unviersity Health Services (UHS), Primary Care Physican, Urgent Care, Pharmacist, etc.). At-home test results cannot be accepted.

-Military Orders: Only official military orders will be accepted. Please complete this form as soon as your orders are received. An official copy of the orders must provided as soon as possible, which may be after the date of initial absence.

-Religious Holidays and Observations: If you plan to observe a holy day pertaining to your religious faith, and the observance will require you to miss class meetings and/or complete assignments, examinations, or other course requirements on the due date, you should complete this form prior to the date(s) in which the holy day occurs. Documentation from clergy may be required if the holy day is not listed on common multi-faith calendars.

-Legal Obligations: Only official legal orders will be accepted. Documentation must be signed by an appropriate official, and include dates of absence.

Final approval of all absences and missed work is determined by the instructor.

Requests will generally be processed within 48 hours. Requests are generally not processed on weekends. The Office of Student Outreach & Support reserves the right to grant or reject notification requests at any time.

**Please note that staff within the Office of Student Outreach & Support are Mandatory Reporters under University's Title IX policy. Any sexual harassment, sexual assult, dating or domestic violence, or stalking reported must be shared with the Office of the Title IX Coordiantor

BEFORE YOU BEGIN: If there is an immediate threat to self, others, or property immediately contact the UTC Police Department at (423) 425-HELP/4357 or 911. Although referrals are reviewed on a regular basis, this form is NOT designed as an emergency response notification process.

Background Information

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Student Information

Full Name

UTC ID Number

Cellular Telephone number

Email address

Questions

Confirm UTC ID(Required) This field is required.

Confirm Cellular Telephone Number(Required) This field is required.

Date(s) of Absence: (mm/dd/yyy - mm/dd/yyyy)(Required) This field is required.

Type of Absence(Required) This field is required.

Further Explanation:(Required) This field is required.

Acknowledgement: By signing this form, I attest that I am a current University of Tennessee at Chattanooga (UTC) student (or parent/guardian of a student). I am requesting that course instructors be notified of my need for absence(s). I understand that all requests, with the exception of Military Obligations and Religious Holidays/Observations, are leniency requests approved at the discretion of the individual course instructor. Moreover, I attest that all of the information provided in this request is true and accurate to the best of my knowledge. I understand that falsifying, withholding information, or providing false supporting documentation is a violation of the Student Code of Conduct. Electronically sign by typing your full name below(Required) This field is required.

Supporting Documentation

Please attach any documentation supporting your request. Documentation may include items such as as a doctors note or other medical documentation, obituary or death certificate, military orders, court orders, etc. Requests cannot be considered without documentation.1GB maximum total size. Attachments require time to upload, so please be patient after submitting this form. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.