This form is only for 1st and 2nd year students.

If you are a 3rd or 4th year student, please use this form (Click Here) and email it to clinicaleducation@bcomnm.org

Thank you.

  • Student Information


  • Absence Details


  • (i.e. Doctor's note, student organization conference registration, etc).
    Drop files here or
  • Students are required to list courses or events that will be missed during absence. Please list in detail the affected course or event, e.g., exam, lab, quiz, etc., the date of the event, and instructor or event contact.
    Course or EventDate(s) of Course or EventInstructor or Event Contact 
    Add a new row