Center for Eye Care

Online Request for Absence (SQL version 3.0)

Today's Date:

NOTE: CEC policy requires that a request for absense must be made with a minimum of four (4) weeks notice. Additionally, requested absences around holiday weeks/breaks or the first or last week/day of any rotation will most likely not be approved. Request for an absence from an HEC assignment on Saturday will not be approved.

Please acknowledge the statement below:

  I understand this is a "request form" and not a "notice given" form :

 

 Student Name

 

 Student E-mail Address

 

 Graduation Year 

 

 Site

 

 Service  
 Attending

 

 Date(s) of Absence(s)

 From: Please select the date   

To: Please select the date

 Reason
Max 500 characters.
 

 
 Proposed Method of Make-up
Max 500 characters.
 
 

        

Webmaster:Dr.Ralph Garzia & Mayur Soneta
Last Updated: October -19- 2006