Completion of this form constitutes a request.
Date of last update: October 2018
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)
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.
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: ___________________________
2) __________________
4) ___________________
6) ___________________
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click to sign
signature
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click to sign
signature
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