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COVID-19 Absence Self-declaration Form
COVID-19 Absence Self-declaration Form
The University provides this self-declaration form for you to complete if you cannot write an exam, submit an assignment on time, or attend a mandatory lab because of COVID-19. With this self-declaration form, you do not need a medical certificate.
Please note that this form is for COVID-19-related absences only. If you are absent for other medical reasons, please refer to
Academic Regulation 9.5
.
Also note that this form shouldn’t be used for Faculty of Health Sciences clinical placements, undergraduate medical education courses, postgraduate medical education program, Common Law courses, or CO-OP or Faculty of Education work term placements.
You must complete and submit this form within 5 business days of your absence or your assignment deadline. Please complete one form for each day you are absent. You must also notify your professor as soon as possible.
This form does not replace requests for deferred exam. Please refer to the
exams
webpage to understand the procedures for requesting a deferred exam by Faculty.
For more information on COVID-19 prevention and the latest key updates, visit the
University COVID-19 website
and the
Ontario Public Health Measures and Advice webpage
regularly.
Information
Student number:
*
First name:
*
Last name:
*
Email:
*
Course
Course or exam date, or assignment deadline:
*
Reason:
*
Diagnosed with COVID-19 by doctor
Flu-like symptoms but no official diagnosis
Caring for someone diagnosed or who has flu-like symptoms
Other reason related to COVID-19
Course code 1:
*
Course code 2:
Course code 3:
Course code 4:
Course code 5:
Please leave this field blank: