Completion of this form constitutes a request.
Date of last update: October 2018
1
Request for Excused Absence for Significant Event
This form should be completed and submitted a minimum of two weeks before the event, or as soon as
qualification/invitation occurs, if less than two weeks’ notice is not available.
Please see reverse side for additional instructions regarding submission.
Event Details (to be completed by student)
Varsity Athletic Event
Athletic Event
Other Significant Event
Level of Event: Provincial National International _________________________
Event Organizing Body:_______________________________________________________________
Dates of requested absence:___________________ Date(s) of event: _____________________
Nature of Invitation: __________________________________________________________________
Description of Event:
For international events, students must register with the Off-Campus Activity Safety Policy (OCASP)
after securing academic consideration. I agree to register with OCASP.
Event Verification
I verify that _____________________________ (name of student) has a commitment to attend the
event described above. I support this student’s request to participate at this event. The student is aware
of their obligation to negotiate a plan for the completion of all assigned work and academic obligations,
and to comply with any conditions associated with the absence.
Varsity Athletic Events (to be signed by the Executive Director of Athletics and Recreation or
delegate)
Name: _______________________ Signature: ______________________ Date: ___________
Other Athletic and Significant Events (to be signed by the Vice-Provost and Dean of Student
Affairs or delegate)
Name: _______________________ Signature: ______________________ Date: ___________
Associated Conditions, if applicable: ______________________________________________
Student S
ignature:________________________________ Date: ___________________________
Student Name: __________________________
Student Number: _________________________
Queen’s Email: __________________________
Faculty/School: __________________________
Phone Number:___________________________
Year of S
tudy: ___________________________
Courses:
1) __________________
2) __________________
3) ___________________
4) ___________________
5) ___________________
6) ___________________
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Completion of this form constitutes a request.
Date of last update: October 2018
2
Student Responsibilities Varsity Athletic Events
Send the following information to your Faculty/School Office:
1. Completed Request for an Excused Absence for a Significant Event Form
2. Supporting documentation from Athletics and Recreation containing travel itinerary and
team travel list
3. Course instructor’s information (i.e., course code, name, and email address)
4. Specific details about deadlines that will be missed, including the course, name of
deliverable and date (e.g., CHEM 112 midterm on October 1
st
, BIOL 102 assignment #4
due October 3
rd
, etc.)
Student Responsibilities Other Athletic and Significant Events
Send the following information via email to vpdean.sa@queensu.ca:
1. Completed Request for an Excused Absence for a Significant Event Form
2. Personal statement outlining why participation in the event is significant to both the student
and Queen’s University
3. Copy of invitation to participate
4. Other relevant details about the event (e.g., tournament information, name of team,
countries participating in event, number of teams participating in event, tournament
schedule, tournament website, etc.)
5. Course instructor’s information (i.e., course code, name, and email address)
6. Specific details about deadlines that will be missed, including the course, name of
deliverable and date (e.g., CHEM 112 midterm on October 1
st
, BIOL 102 assignment #4
due October 3
rd
, etc.)
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