Northwestern Athletics
Academic Services & Student Development

Student-Athlete Travel Excuse/Missed Class Request Form
Each student-athlete is responsible for completing the Travel Excuse Request Form for every away competition. This form should also be used when missing class due to athletically related injuries and/or surgical procedures.
If you will be missing a test or quiz due to travel you must complete this form at LEAST ONE WEEK prior to your departure from campus. Remember, each student-athlete is responsible for following up with the professor and making up any missed work.

Today's Date:

Student Name (First and Last):
Student Sport:
Best Phone Number To Reach You:
Student Email:
Destination / Event:
Depart From Campus on:
Include Date AND Time:
Return to Campus on:
Include Date AND Time:

ARE YOU MISSING A QUIZ OR EXAM DUE TO TRAVEL?
Yes No

If yes, please list the class(es), any arrangements you have made, and if you need our office to contact the professor to confirm a traveling exam/quiz:

(e.g.: I am missing a HIST 3XX exam. I have talked with the prof, he is willing to travel the exam, and is waiting for your follow-up e-mail with the arrangements.)

TO WHOM LETTERS/EMAILS SHOULD BE SENT:

Missed Class #1

  1. Department/Class #/Day/Time:
    (Example: PSYCH 110 Tu/Th 10:30am-12pm)
  2. Prof./T.A./Name & Email:
    (EX: Professor Jones, p-jones@northwestern.edu/T.A. Smith, t-smith@northwestern.edu)

Missed Class #2

  1. Department/Class #/Day/Time:
    (Example: PSYCH 110 Tu/Th 10:30am-12pm)
  2. Prof./T.A./Name & Email:
    (EX: Professor Jones, p-jones@northwestern.edu/T.A. Smith, t-smith@northwestern.edu)

Missed Class #3

  1. Department/Class #/Day/Time:
    (Example: PSYCH 110 Tu/Th 10:30am-12pm)
  2. Prof./T.A./Name & Email:
    (EX: Professor Jones, p-jones@northwestern.edu/T.A. Smith, t-smith@northwestern.edu)

Missed Class #4

  1. Department/Class #/Day/Time:
    (Example: PSYCH 110 Tu/Th 10:30am-12pm)
  2. Prof./T.A./Name & Email:
    (EX: Professor Jones, p-jones@northwestern.edu/T.A. Smith, t-smith@northwestern.edu)
 
Press to send your form or press to clear your form.

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