ࡱ> egd bjbjVV 4 <<WWWWWkkkk4kx9;;;;;;$2_W_WWtWW99pfk5F%0{W| hTC__3v :  ALABAMA A & M UNIVERSITY DEPARTMENT OF COUNSELING & SPECIAL EDUCATION Communicative Sciences & Disorders Program P.O. BOX 357 NORMAL, AL 35762 REQUEST FOR ABSENCE FROM CLINICAL PRACTICUM AND/OR CLNICICAL PRACTICUM CLASS Date: To: Ms. Esther Phillips-Embden, Clinic Director Mrs. Cynthia Lewis, Clinic Supervisor I, am requesting an excused/unexcused absence from clinical practicum/clinical practicum class on the following date(s) and times with the following clients (list clients initials): I am requesting the absence(s) for the following reasons: I understand permission for a foreseen absence should be made at least 7 days prior to the requested date. In case of emergency, a request for Absence from Clinical Practicum/Clinical Practicum Class should be made 24 hours post absence. Excused absences for clinical practicum follow the same guidelines as an excused University absence as outlined in the undergraduate and graduate Bulletin. Attach necessary documentation to this form upon submission (i.e. medical doctors excuse, note from clergy, etc). I understand if granted an unexcused absence, 2 points will be taken away from my final semester grade. Student clinicians initials:________________. I am responsible for obtaining a substitute student clinician to cover the aforementioned session(s). I am also responsible for writing the lesson plan for the session date(s). The substitute student clinician is responsible for writing the progress note(s) for the session(s). I understand that I am to contact my clinical supervisor and clinical director before cancelling clients session(s). Student clinicians initials:_________________. Comments from Supervisor regarding excused absence request. Request for an excused absence __has been granted __has not been granted. 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