The following appeal form is utilized when a student misses more than their 2 allowed clinic shifts (per quarter) or does not attend clinic without notice. Both of these instances results in failure of clinic. This form gives the student the opportunity to appeal the decision.
In your appeal, please include the following.

1. What caused the problem and/or absence?
2. What is your plan moving forward to prevent the problem and/or absence from reoccurring?
3. Provide a detailed action plan describing the actions you plan to perform.