University of Nottingham
Faculty of Medicine and Health Sciences
EXTRACURRICULAR ACTIVITIES LEAVE REQUEST FORM
Guidance on Completing the Form
Attendance on all aspects of the course is compulsory, however the School of Medicine recognises the importance of student involvement in extra-curricular activities.
The purpose of this form is to allow students attending the clinical years of the course (Clinical Phases 1, 2 and 3) to request time off from timetabled activities on their clinical placements in order to attend extra-curricular activities.
Examples of acceptable reasons for absence include:
• BUCS (British University and College Sports) matches
• University music performances
• University drama performances
Please note that this form should not be used to request absence for regular sessions (such as weekly training or rehearsals), as attendance on clinical placements is compulsory.
We will not approve any requests that would lead a student to miss mandatory teaching sessions, MACCS sign off sessions or an assessment (including mid- and final- sign-offs). Please ensure that you have checked with your educational supervisor and undergraduate co-ordinator at your placement that arrangements can be made for you to make up any clinical activities or teaching that you have missed.
Students will still be required to complete all of the components needed to pass the attachment; in cases where taking leave from the course for an extra-curricular activity may put a student at risk of failing an attachment, the Service Centre reserves the right not to approve a student’s application for leave. Please also keep in mind that students whose attendance falls below 75%, will fail their attachment, as stated in your Clinical Phase Handbooks/Study guides.
Students attending the early years of the course (on years 1, 2 and 3 of the A100 course) have no timetabled activities on Wednesday afternoons and are therefore ineligible to request leave using this form. They may, however, use the Planned Absence Request Form if they would like to request time away from the course. In addition, students in years 1 and 2 of the Graduate Entry Medicine course may apply for leave by requesting an Authorization of Absence, which would include attendance at extra-curricular events.
The Planned Absence request form and the Extracurricular Activities Leave Request form can be found at:
MEDICAL STUDENT EXTRACURRICULAR ACTIVITIES LEAVE REQUEST FORMSurname: / Forename:
Student ID: / Year of study:
Date of requested leave:
What attachment will you be on?
At which site will you be based?
On what date did/will the attachment start?
Reason for Requested Leave:
Student Signature: / Date:
For completion by extra-curricular activity lead:
Name / Position
For completion by educational supervisor or undergraduate coordinator:
Name / Position
Please submit this form in person to the QMC Student Service Centre or by email to at least 2 weeks in advance of the date of your requested leave.
FOR OFFICE USE ONLY
Approved / Not Approved / Requires meeting with Director of Student Wellbeing
Reason if not approved:
Signed: / Date:
University of Nottingham – Faculty of Medicine and Health Sciences
Version 2 – Updated 17/08/2018