Year 1 (GEP) Medicine in Society Self-Reporting Absence Form 21/22

Year 1 (GEP) Medicine in Society- Self Reporting Absence Form 21/22

This form should only be used by students in Year 1 (GEP) MedSoc Placement.
Any queries, please contact the year 1 CBME administrator via email f.langridge@qmul.ac.uk

For students who have missed teaching or placement days due to illness:

This form should be completed if you have been unable to attend your studies.

For students requesting leave in advance:

Please complete all parts of this form if you wish to request a period leave which requires you to miss learning events for Year 1 GEP Medicine in Society
Name*

PrefixFirst NameLast Name
Student ID*
Enter 9 characters
QMUL Email*

Confirmation Emaila.student@smd18qmul.ac.uk
Phone Number*

Area CodePhone Number
Group*
Absence or leave request
Name of Placement / Practice*
Lead Tutor*

PrefixFirst NameLast Name
Tutor Email*

Confirmation Email
Dates(s) of absence
Reason for Absence
Placement Informed*
Please use this space to provide any further comments
Please be aware that the Student Academic and Pastoral Support Office at QMUL Barts & the London School of Medicine and Dentistry is available to you, where you can receive support from our staff who are experienced in helping and advising students across a range of issues.

If you have a physical or mental health condition or concern, you are strongly encouraged to contact the Student Academic and Pastoral Support Office who will provide help and guidance to minimise any negative impact on your studies and/or academic progress.

To make an appointment you can email smd-student-support@qmul.ac.uk or call 020 7882 2234
Leave Requests
The following two fields should be completed by those submitting requests for leave from their placement or teaching in advance.
Please give brief reason for your leave request:
What plans have you made to make up the learning opportunities missed? Please give as much detail as possible including dates and with whom you have discussed your plans.
Should be Empty:

Year 1 (GEP) Medicine in Society- Self Reporting Absence Form 21/22