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Winter ESP Medical Self-Declaration

Winter ESP Medical Self-Declaration Form

This form is for students in the Enriched Support Program only. Non-ESP students, please contact the Registrar’s Office for medical self-declaration forms.

ESP students: Please only use this form for absences from Winter ESP workshops and CIED and FYSM classes .

For absences from your lecture courses, please contact your professor.

You cannot use this form for any missed exams. Please refer to the Registrar’s Office for exam deferrals.

This form is for short-term illness (if you have a chronic health condition, you must arrange accommodation through the Paul Menton Centre), or for varsity athletes to report game day absences.

This form will be submitted to the ESP Main Office. Please follow up with them for more information if desired (esp@carleton.ca).

Personal Data

Name(Required)
Please follow the format firstnamelastname@cmail.carleton.ca with no dots between your first and last name.
Course(s) Affected by Medical Issue(Required)
Select all that apply

Note: Medical self-declaration is for short-term illness only. For absence due to chronic illness or disability, you must seek accommodation from the Paul Menton Centre.

Absences will not be excused for transit/travel, competing deadlines, employment, or family/social obligations.

ESP accommodates varsity athlete absences for games, but not practices. For game-related absences (travel or game day), athletes must provide their game schedule to the ESP main office to have their absences excused.

Please write down the date you missed/will miss the ESP course or workshop(s) listed above.
Confirm each of the following with a checkmark.(Required)