STUDENT MEDICAL DOCUMENTATION FORM
Please print this form, fill it in completely, and hand it over to the course instructor. Do not e-mail the form.
Students who are ill for a week or longer must attach a written note from the Health Center or personal physician (on the doctor's letterhead) detailing the nature and the duration of the illness.
I was unable to attend the (check one)
___ discussion session
___ seminar session___ exam
due to an illness of such severity as to prevent me from attending.
(time and date)_________________________________________
to (time and date)_______________________________________
I pledge on my honor that all statements on this form are true.
Last name, First (PRINT)_________________________________
Student ID No._________________________________________
I am enrolled in ARCH _______, Section No._________________