Attestation Form For Medically Necessitated or Covid-related Absences or Missed Course Expectations


This template is provided for consistency and in accordance with the University of Maryland Policy on Excused Absence: V-100(G) University of Maryland Policy on Excused Absence (Exception for Fall 2020):

Please refer to your course syllabus for the communication method set by your instructor to communicate information for excused absences.

According to the Excused Absence Policy, you are expected to notify your instructor in a timely manner. Please send this note prior to the absence or as soon afterwards as possible.

In the case of religious observances, athletic events, and planned absences known at the beginning of the semester, policy requires that you inform your instructor during the schedule adjustment period.

For all other absences or missed course expectations (such as assignment due dates or exams), send this note to each instructor as soon as possible.




Dear Professor _____________,

I am a student in your course _______, section _____.

On _______________________________ (indicate dates), I was or will be unable to meet the expectation for ____________________________ (indicate assessment that was missed: quiz, test, assignment due date, etc.).

Reason for missing: ________________________________________________________

(It is not necessary or required to disclose private medical or diagnostic information.)

I understand that providing false information to University officials is prohibited under Part 10(j) of the Code of Student Conduct (V-1.00(B)) and may result in disciplinary action. I pledge on my honor that I have not provided false information.

Please let me know how I may make up the missed course expectation.

Your Name:

UID:

Email: