Emergency Excuse Request And Procedure Form 

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Provide The Following Information                                                                                                                         Dean of Students 

Contact Information

School Information

If requesting an incomplete grade ("I") in a class for extenuating circumstances, please provide the course and faculty name:

If requesting an Emergency Excuse Verification, please provide course and faculty name:

Dates for excuses 

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Emergency Excuse Request and Procedure 
The Office of the Dean of Student Life (ODSL) should be notified by the student, or in the event the student is incapacitated a friend or family member, if she/he misses class due to: serious illness, hospitalization, serious illness or death of close family member; military responsibilities or court orders which threaten the student's academic progress. The office is available to ease the burden for family members that are acting on behalf of students, when they are unable to do so themselves. 
When a student has missed consecutive classes for an extended period (6 missed classes in a course that meets 3 times per week, 4 missed classes in a course that meets 2 times per week, and 2 missed classes in a course that meets 1 time per week), then the student or designee must complete the Emergency Excuse Request (EERP) and return it to the ODSL within five business days from the last date of missed classes as referenced above. The appropriate documentation must accompany the request when submitted. Please review the information under Emergency Excuse Classifications for directions. The Dean of Students reserves the right to grant or reject EER requests for failure to comply with the procedures.  Absences that are outside the guidelines mentioned in this paragraph must be addressed directly with the instructor/professor. If circumstances arise that make this challenging, contact the Dean of Students Office for assistance. Non-Emergency Excuses (Minor illness, regular doctor's visit, dentist appointments, etc.) The ODSL will not provide an excuse for non-emergency situations.
The EERP must be submitted to the ODSL in order to verify the circumstances, take action, and advocate on the student’s behalf. The office may take steps to call medical providers or others to validate any documentation submitted. The student may be asked to provide a permission waiver form from the medical establishment allowing the ODSL to request medical records. Submission of false documentation is a Student Code of Conduct violation that could result in disciplinary action. Once information has been received and verified, an excuse letter will be sent to the faculty requesting an opportunity to make up any missed assignments and exams. Communication will be disseminated via UAPB e-mail.  
The student is responsible for following up with faculty members to discuss arrangements for completing academic course assignments that were missed. 
If the student requests an incomplete grade (“I”) she/he must submit a written petition, which is separate from the EERP, to the instructor/professor as outlined in the ‘Academic Regulations and Guidelines’ section of the ROAR. 
The final decision regarding an incomplete due to extenuating circumstances will be determined in consultation with Faculty, ODSL, and the Office of the Provost/Vice Chancellor for Academic Affairs. 
Any requests for accommodations due to a qualified, documented disability or military leave should be submitted to the Office of Disability Services and Veteran Affairs. Pregnancy does not qualify for ADA protection provided it is of normal duration without severe complications. 
Once grades are submitted to the Office of the Registrars (including a single grade for a course or grades for multiple courses) a student can no longer request an incomplete grade unless there are extenuating circumstances.
Emergency Excuse Classifications  Medical Emergency – Students may request an excuse for specific dates due to illnesses or special medical circumstances.  Documentation that the student is under the care of a physician and that information must be presented on medical practice letterhead with the name and phone number of the provider/practice, signed and dated by the attending physician, and include the dates of treatment as well as the student's anticipated date to return to class.
Personal/Family Emergency – Students may request an excuse for specific dates due to special circumstances involving an immediate family member (spouse/partner, parent, sibling, child, grandparent, custodial aunts/uncles, guardians, etc.). The ODSL must be able to establish a relationship between the student and the immediate family member in order to advocate for an academic accommodation.
In cases of family illnesses, students must provide medical documentation, which must be presented on medical practice letterhead, signed and dated by the attending physician, and include the dates of treatment. The ODSL must be able to verify student’s relationship with the immediate family member.
In the unfortunate circumstance students may experience the loss of immediate family member(s), they must provide an obituary, memorial service pamphlet, or other documentation that identifies the student’s relationship to the deceased. Such documentation must include date of the family member's passing, date of funeral/memorial service, and the city and state the services were held.
Military Leave – Students may request an excuse for specific dates when called to military duty. They must provide copies of official military orders signed and dated by a commanding officer/designee. The orders must be sent to the Office of Disability Services and Veteran Affairs for verifying.
Court Orders – Students may request an excuse from classes when being called to jury duty, subpoenaed to appear in court as a witness, and as a defendant. They must provide copies of official court documents to the ODSL for verification. 
Incomplete Grades - A student may request the assistance of the ODSL when submitting an accommodation for incomplete grades for all courses within the current term. Request for Incomplete may be considered for students that have a documented extenuating circumstance that prevent them from meeting the specific requirements for a course. For complete information about the incomplete grade requirements, please refer to the ROAR Student Handbook. Just as a reminder failure to comply may result in your request not being approved. ext