NOTE: Full documentation is required for all requests (e.g. hospitalization records, letter on letterhead from medical professional documenting dates and extent of illness, obituary in case of death of an immediate family member, etc.). All supporting documentation submitted with this request will be kept confidential. Submission of false statements and/or documentation will result in referral to the Office of Student Conduct and possible dismissal or suspension from the University.
I heave read the information above and will provide documentation as needed. By completing this form, I affirm that the statement and documentation I have provided are accurate.
In addition to completion of this form, requests will require the submission of the appropriate form as well. Please make sure to complete the appropriate form with all necessary information.
Please note, submission of this form does not guarantee approval of your request. A student services team member may follow up with you on the nature of your request.
