Time Away Request

Student Affairs

200 University Parkway, Suite 317

Yakima WA 98901

Phone: 509-249-7724

Fax: 509-249-7909
Time Away Request

- If for illness, please contact Judy O'Neal at nurse@pnwu.edu after this form is completed.
There must be an appropriate reason and documentation for time away from lectures, labs, rotations, and other assigned functions. Failure to comply may result in disciplinary action.

Extended time away may have an adverse effect on academic progress and financial aid.

To allow adequate time for approval, please submit all requests at least three (3) weeks prior to time away date request.

For emergency, unplanned time away requests (eg: illness, funerals, etc.) please contact student affairs at studentaffairs@pnwu.edu.
Student Information
Name*

First NameMiddle NameLast Name
PNWU ID (no dashes)*
Class Level*

OMS 1OMS 2MAMSDPT IDPT IIDPT IIIMSOTSchool of Dental Medicine (AY 25/26)
Group

AB
Email*
Cell Phone Number*

Area CodePhone Number
Time Away Information
Type of Leave*
Please attach any necessary documentation for your Time Away Request: (wedding invitation - or information regarding wedding party involvement/family relation, conference registration confirmation, doctors note, medical appointment upload, etc.)

Upload a File

Cancelof
If "other" please explain:
Start Date/Time*

MonthDayYearHourMinutesAM/PM Option
End Date/Time*

MonthDayYearHourMinutesAM/PM Option
Explanation of need for Time Away:*
Is this a national meeting for a PNWU club in which you hold an office?*

YesNo
If yes, which PNWU club?

COSGPSOMAAPTASOTAOther
Please indicate the officer position you hold with your club:*
Are you presenting at this conference?*

YesNo
If yes, please upload documentation to verify that you will be presenting.

Browse Files

Cancelof
Are you missing an exam while attending this conference?*

YesNo
How many conferences have you attended this academic year?*

0123 or more
Name of Conference
Location of Conference
Dates of Conference (start date with time/end date with time)
How will airfare be purchased?

Self-purchase for reimbursementPNWU purchasing
Full Legal Name for Airfare

First NameMiddle NameLast Name
Date of Birth for Airfare

MonthDayYear
Date
Alaska Airlines Number
Departure Airport
Destination Airport
Departure Date

MonthDayYear
Date
Preferred Flight Times for Departure
Return Date

MonthDayYear
Date
Preferred Flight Times for Return flights
Missed Coursework and Exams

Note: Please be aware that the dates and times for completing missed coursework/quizzes/exams will be at the discretion of the course director in coordination with the assessment coordinators. It is the student’s responsibility to initiate contact with the course director and assessment coordinators to make these arrangements once the request is approved. All assessments (quizzes and exams), assignments, and other academic activities such as labs must be made up within five (5) business days after returning from an excused absence, unless an extension was authorized by Student Affairs. For any excused absence that falls during the final two days of a course, make up assessments must be completed within three (3) business days.
Select OMS I Courses that will be missed*

ANAT 505/506BIOMED 501CLIN 504FM 501/502OPP 501/502PHARM 599CLIN 510 (Spring)CLIN 512 (Spring)Other
Select OMS II Courses that will be missed*

CLIN 616CLIN 618CLIN 627CLIN 628FM 601/602OPP 601/602CLIN 603 (Spring)CLIN 604 (Spring)CLIN 625 (Spring)CLIN 629 (Spring)
Select MAMS Courses that will be missed*

BIOMED 505BIOMED 507BIOMED 509BIOMED 511BIOMED 506 (Spring)BIOMED 508 (Spring)BIOMED 510 (Spring)BIOMED 512 (Spring)Other
Select DPT I Courses that will be missed*

PHTH 500PHTH 501PHTH 505PHTH 506PHTH 510PHTH 512PHTH 513PHTH 514PHTH 515PHTH 516PHTH 520PHTH 521PHTH 543PHTH 545PHTH 550CE Seminar 600Other
Select MSOT courses that will be missed*

OTH 500OTH 505OTH 510OTH 515OTH 520OTH 525OTH 530OTH 535OTH 540OTH 545OTH 550OTH 555OTH 560OTH 565OTH 605OTH 610OTH 615OTH 620OTH 625OTH 635OTH 640Other
Select DPT II Courses that will be missed*

PHTH 602PHTH 607PHTH 608PHTH 620PHTH 621PHTH 622PHTH 625PHTH 626PHTH 635PHTH 644PHTH 645PHTH 646PHTH 647PHTH 650CE Seminar 700Other
Select DPT III Courses that will be missed*

PHTH 709PHTH 722PHTH 723PHTH 727PHTH 736PHTH 746PHTH 748Other
Should be Empty:

Time Away Request

Student Information

Time Away Information

Missed Coursework and Exams