COLLECTIVE BARGAINING AND ADMINISTRATION

Fall 2013 HRIR 4480 – A01 Fall Term 2013

Monday and Wednesday 4:00 p.m. - 5:15 p.m. Room 103 Drake Centre

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Instructor: Janet Eisbrenner Office Location: 360 Drake Centre Phone: 204-781-9884 Office Hours: Mon/Wed by appointment Fax: 204-474-7545 Class Room : 103 Drake Centre Email: eisbren4@d2l.umanitoba.ca Class Time: Monday & Wednesday 4:00-5:15 p.m.

I. COURSE DESCRIPTION

This course presents collective bargaining and administration from a human resource and industrial relation stance. Major course themes include an overview of collective bargaining in the context of labour relations, administration of the collective bargaining agreement and negotiation of the collective bargaining contract. Both public and private sector collective bargaining will be explored. The focus will be from a Canadian perspective with insight from other national systems. Aspects of collective bargaining will be examined in terms of the nature of collective bargaining, understanding unionization, dispute resolution processes and legal frameworks. Implications of contract negotiation and its impact on organizational administration of grievances will be a prominent topic throughout the course. The course will also explore the unfolding of conflict in the workplace, issues of concern and the administration of organizational disputes in a collective bargaining environment.

II. TEACHING METHODS

This course is largely interactive-based and involves a combination of lecture, group discussion and exercises, simulation drills, role plays, group presentation and class dialogue. The course will be supplemented by audio-visual materials, power points and hand-outs. Preparatory work for class such as assigned reading is expected of each student. Informed participation will be a significant course evaluation factor. The course is designed to encourage interdisciplinary discussions of a variety of forms that are integral to collective bargaining and administration in a Canadian context.

III. COURSE OBJECTIVES:

1) Foster an understanding of theoretical and practical aspects of collective bargaining. 2) Become familiar with a variety of terms and concepts related to collective bargaining and

administration in the context of organizational dispute resolution. 3) Enhance knowledge of organizational conflict and ways in which to better resolve and

manage workplace difficulties. 4) Comprehend the benefits and potential drawbacks of a collective bargaining agreement in

terms of dispute resolution, organizational and individual goals. 5) Compare and contrast industrial relation and human resource perspectives and explore

harmonizing the perspectives in relation to collective bargaining and administration.

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6) Increase awareness of the legal framework imposed on collective bargaining processes. 7) Analyze traditional and non-traditional grievance procedures and administration implications. 8) Design and propose effective strategies in the context of collective bargaining. 9) Prepare and participate in negotiation simulations, third-party intervention role-plays and

grievance process exercises in a collective bargaining environment.

COURSE MATERIALS

Required Course Texts:

Suffield, Larry. (2012), 3rd Ed. Labour relations Toronto: Pearson Canada Inc.

Asper Business School of Business, Faculty of Management. Prepared by: Eisbrenner J., (2013). HRIR 4480 A01. Collective Bargaining and Administration Course Pack, Fall 2013. (2nd ed). Winnipeg: University of Manitoba Digital Copy Centre.

E-Reserve: Applications in Human Resource Management: Cases 93, 94, 95; exercises 96, 97, 98; 99

Optional Course Readings – (On library course reserve)

Cloke, K. & Goldsmith, J. (2011). Resolving conflicts at work: Ten strategies for everyone on the job. San Francisco: Jossey-Bass.

Fisher, R. & Ury, W. (2011). Getting to yes: Negotiating agreement without giving in, New York: Penguin Group.

Lewicki, R.J., Barry, B., Saunders, D.M., & Tasa, K. (2011), 5 Ed. Essentials of Negotiation. (Canadian Edition). New York: McGraw-Hill Irwin.

Moore, C. (2003). The mediation process: Practical strategies for resolving conflict, 3rd Ed. San Francisco: Jossey-Bass.

Gunderson, Morley and Taras, Daphne. (2009). Canadian labor and employment relations, Calgary: Pearson Education Canada.

COURSE EXPECTATIONS

1) It is anticipated that you will attend every class on time and stay for the entire session. If you have an unavoidable conflict that prohibits this, please make an effort not to disturb your classmates or interrupt the session. Please let me know prior to a session if you will be absent.

2) Every class requires the participant’s active participation in a meaningful way that enhances group learning. It is important that you complete assigned readings and case study questions including review of the pre-posted slides prior to class so that you may dynamically participate in course activities.

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3) Active engagement in small group and class discussion is expected. Quality discussion includes offering a unique and relevant perspective, moving the analysis forward, providing evidence, demonstrating recognition of course material and integrating these with reflective thinking; and linking course concepts and themes to current events.

4) This course is registered on the university’s learning management system Desire2Learn (D2L) site. It is anticipated that you will regularly check this site for important instructor information regarding news events, discussion forums, upcoming agendas, calendar events, course content material, up-coming in-class discussions, and assignment supplemental information.

COURSE ASSESSMENT

Student progress will be assessed through the following:

Course Assessment Details:

1. Written Assignment 1 – Assignment Due Wednesday, September 25, 2013

This assignment is a reflection on the administration of labor force issues in a work environment. It requires you to integrate information provided in the readings and the classroom. Refer to the syllabus’ section - Additional Assessment Notes -for submitted written work requirements. For this assignment, consider a past or present work experience and reflect on two or three labor force issue and the administration of these. Formulate your response around the following prompts:

Provide brief introductory comments relevant to the assignment

Present a brief description of your work place and also note whether the workplace is a union or non-union environment.

ASSIGNMENTS / EXAMS VALUES DUE DATE

Written Assignment 1 5% September 25

Written Assignment 2 10% October 16

Mid-Term Exam 15% October 23

Assignment 3 – Negotiation Simulation

10% November 6

Group Project: (Total worth 25%)

a) Presentation Outline (Optional)

b) Presentation

c) Written Report

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15% 10%

November 18

November 25, 27 & Dec 2 December 2

Final Exam 25% TBA

Participation 10% -

Total 100% -

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Identify and explain some labour force issues that you see and give possible reasons why they may be occurring and some factors involved. (i.e. leadership, cultural dynamics, management, communication).

Discuss if administration of difficulties is more so from an industrial relations perspective, a human resource perspective or a combination of both. Explain.

Provide thoughts on the benefits and/or drawbacks to the ways in which the administration of various labor force related issues are carried-out in your workplace. Bring forth ways in which you believe the work environment may be improved.

Concluding thoughts in relation to your theme presented in your introduction

This assignment is worth 5%. It should be 850 words, 2 ½ pages double-spaced.

2. Written Assignment #2 – Assignment Due Wednesday, October 16, 2013

Discuss the implications of collective bargaining in terms of discrimination, wages, discipline, seniority, leave or health and safety issues. You are to choose one of these issues and put it in a particular context. This context will form the discussion basis for your paper. Your discussion should integrate course reading , class material, research, and/or recommended reading material that is on library reserve. Remember to include relevant in-text referencing and a bibliography. The following are prompts to guide your discussion:

1) Introduction – Your introduction should bring forth a particular discrimination, discipline,

seniority or health and safety issue. (i.e. A discrimination issue: an employee at 65 being told that he or she has to retire but they do not want to do so) You will explain what your paper will set out to show in terms of discussing this issue in the context of collective bargaining and administration.

2) Provide a brief overview of the discrimination or health and safety issue and explain what provisions might be included in the collective bargaining agreement in terms of this issue. Discuss the implications of the provision.

3) Examine provincial and federal legislation that covers the issue. (You will have to do some research for this). Discuss why a collective bargaining agreement may include specific provisions relating to the issue even though there is legislation.

4) Explore if there is a basis for the union to file a grievance of your issue. 5) Discuss how a grievance procedure might unfold, if a grievance was filed in this case. 6) Explain any problematic aspects of the grievance procedure that you see - is there any

problematic aspect of the arbitration component, for instance? 7) Concluding Remarks. (Tie together the topics discussed in your content paragraphs)

This assignment is worth 10%. It should be 1000-1100 words, 3 ½ - 4 pages double-spaced.

3. Mid-Term Exam (15%) – Wednesday, October 23, 2013

The term exam will test your knowledge of the topics covered to the exam date. Additional information will be provided in class.

4. Negotiation Simulation –Wednesday, November 6, 2013

In groups of 3-4, you are to present a negotiation simulation to work through a conflict issue in the context of an organization with a collective bargaining agreement in place. You will be given some

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class time to research and/or formulate your case and to prepare for the role play. Expect to do a small amount of study of the case and preparation on your own time. There is no written component to this assignment. You may prepare a hand-out for the class, if you deem this helpful. Preparation, presentation and other information for this simulation is as follows:

1) Choose or create a conflict case in the context of a unionized environment. Study and familiarize yourself with the case (case examples will be provided to you).

2) Decide roles for each group member (i.e. disputing party(s), mediator, arbitrator…) 3) Prepare an 8-10 minute simulation to present to the class. 4) Your presentation should unfold in the following way: 1) Give a narrative of your case by

providing a brief overview of it (i.e. identify the parties, how the conflict began, the issues, and how the conflict escalated), make clear what part of the grievance process you will present in your simulation, explain whether the procedure to resolve the dispute follows a traditional or non-traditional path, and comment on the type of third-party intervention you will use in your role-play; 2) Perform your simulation; 3) End the presentation at the agreement stage.

5) Q/A period - Each presenting group is to prepare a few questions for the class audience; in-turn, the class audience is to participate by responding to the questions along with providing feedback, insight or asking additional questions. .

You will be graded on: a) organization, clarity and creativity b) content relevant to course themes and concepts; and, c) evident understanding of conflict, negotiation, third-party intervention and administration of contract dispute resolution. This assignment is worth 10% and is graded as a group.

5. Group Project

This is a Group Project research-based case study assignment on collective bargaining and contract negotiation. The project has two components: 1) Written report and 2) Class presentation. For this project, you are to choose a relatively recent contract negotiation. Research the background of the case, the various issues involved and the unfolding of the contract negotiation process. Your research should include a look into the types of bargaining tactics and strategies used in terms of both positional and interest-based. The theme and general purpose of this assignment is two-fold: 1) To research and examine the event and the bargaining used (50%); and 2) To analyze an alternative approach (i.e. interest-based) explaining aspects of this approach that are advantageous as well as any possible obstacles in terms of future relations between the parties and the contract negotiations.

Written Report – Due Monday, December 2

Be sure to integrate course material, class learning and research material into your paper. Refer to the syllabus’ section - Additional Assessment Notes -for submitted written work requirements. Articulate your research and written aspect of this project around the following prompts:

1) Introduction: o Provide introductory remarks to present your paper including a hypothesis statement

(i.e. your prediction if an integrative approach was applied). 2) Scenario Summary:

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o Summarize the collective bargaining conflict scenario making sure to provide information about the participants and their involvement; and the background of events towards the collective bargaining negotiation. (about 1 page)

3) Content paragraphs: (about 5 pages) a) Research the bargaining that was carried out in this scenario and provide an overview. b) Explain the primary issue(s) involved and how these were ultimately resolved and/or

handled. c) Address whether or not you feel all of the issues involved were addressed – i.e. explain

what hidden issues relating to interests that may not have been addressed or were dealt with inadequately. Analyze possible reasons for this outcome.

d) Discuss what may be some short-term and long-term implications of these issues remaining largely unresolved or inadequately addressed. Also, consider and examine levels of impact in terms of the employee, employer, organization, institution.

e) Consider an interest-based or integrative approach to the positional bargaining used - Investigate this type of approach in the context of one of the third-party dispute resolution processes explained in class - mediation; arbitration; mediation-arbitration:

o Examine and explain how one of these processes would look like in the context of this particular collective bargaining event. (i.e. principles, components, stages)

o Explain the role of the facilitator. o Explore what differences to the agreement might be seen if the process you

suggest was applied. o Examine the benefits to this approach in light of all parties and levels involved

and scrutinize any disadvantages or drawbacks to this approach f) Bring forth any other elements from course learning that you deem pertinent (1-2 pages)

4) Conclusion – o Provide concluding comments and remember to include remarks relating to your

hypothesis statement from your introduction.

The paper will be evaluated on the use of reference material, factual accuracy, objectivity, balance, analysis, and an understanding of the dynamics of collective bargaining, administration and negotiation process. Your paper must demonstrate evidence of library research as well as references to course textbooks and readings. Minimum of 8 references - 2 academic journal articles, 3 books outside of course materials, and 3 course articles/text books/lectures. Each group member should be assigned a specific area to be responsible for. A group member(s) should also be assigned to compile, edit, and proofread the final submitted product. You will be evaluated on research and analysis, technical aspect of your content (i.e. comprehension of C/B, bargaining processes and contract negotiation), development of ideas, clarity and mechanics. Your written report should be 1600 - 1700 words, about 7-8 pages, double spaced. (not including the title, appendix and bibliography pages). You may use headings to organize your work. The written component is marked as a group and is worth 10 %. Group Project Presentation – Presentations are on November 25, 27 and December 2

Each group is to present their project to the class. Groups have considerable leeway as to their presentation but it should feature aspects of the written component along with a simulation of a particular area(s) of the contract negotiation. Your simulation can include a look at negotiations

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between the parties and/or a look at third-party intervention, such as arbitration or mediation. Presentations can include power point, hand-outs, posters, simulation activities, role-plays, and class interaction. A question and answer period will follow each presentation. Each group is to prepare questions for the class audience; the class audience can also present questions to the presenting team. Additional presentation details will be provided to you in class. Please note that you are invited to submit a point-form overview of your presentation to your instructor on or November 18 to to obtain feedback regarding your presentation plan (optional). The group presentation mark is evaluated on the following: 1) evident research and analysis, 2) connection to course content, 3) creativity, presentation, Q/A period, 4) strategy developed for an interest-based approach, and 5) simulation technicality and comprehensiveness. Your group presentation area is marked as a group and is worth 15%.

6. Final Exam (25%) – December (Date TBA), 2013

This cumulative exam will cover learning throughout the semester. 50% content is derived from class material, 50% from readings. (Identification is not required; no special tools are required or permitted).

7. Participation

Your participation mark is worth 10% of your final grade. It will be determined by attendance, evidence of course material reading, attention to content on the course learning site – D2 - active presence and participation in ALL class processes including class and group discussions, simulation and role exercises and presentations, and group presentation days. Students using cell phones or internet during class will be deemed absent (unless the purpose is pertaining to course learning during group discussion). Active class participation will be considered an extra that can help a borderline grade.

ADDITIONAL ASSESSMENT NOTES:

1) Assignments are to be handed in electronically by the beginning of class on the due date of the assignment. Assignments are to be submitted to the D2L course site.

2) All assignments must be double spaced and typewritten. Always keep a copy of your work. Use Times New Roman or Arial 12 font. Assignments require a title page that contains your student ID, name, HRIR 4480 – A01, assignment and instructor name.

3) Assignments are to be submitted ON TIME by the beginning of class. There will be a 1 point deduction per day for late assignments. Assignments are not accepted after three days from the due date. An exception to this applies only under special circumstances (i.e. medical) and only through consultation with your instructor. Late written assignments may require supporting documentation from a Medical Doctor.

4) All assignments should include theory and concepts from the text, class lecture and course material. These should be briefly explained and noted how they apply to the particular situation you are discussing. Inclusive language and formal writing is expected. Assignments

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require application of basic rules of grammar, organization, spelling and good communication in response to particular assignment questions.

5) All material referred to in any assignment MUST be appropriately referenced. Plagiarism is a

serious academic offence. Refer to the departmental academic integrity page 12 in this syllabus.

6) All papers for this course should follow the APA (American Psychological Association) in-text citation/documentation format (author’s last name, year of publication and page numbers). Copies of the Publication Manual of the APA are available in the U of M Library and bookstore. You can also user the class hand-out as a reference. Be sure to include a bibliography with your assignment, APA format.

7) Students wanting evaluative feedback prior to the voluntary withdrawal deadline date,

should e-mail me to arrange a discussion time before class or to schedule an appointment.

8) I will re-grade work that is appealed. Grading appeals must include a detailed written description of your concern and reasons why your mark should be changed (based on training and development theory and literature). Subsequent to re-grade, your grade might raise, stay the same, or drop.

FINAL GRADES WILL BE SUBMITTED AS FOLLOWS:

Letter Grade Percentage GPA

A+ 90-100% 4.5

A 80-89% 4.0

B+ 75-79% 3.5

B 70-74% 3.0

C+ 65-69% 2.5

C 60-64% 2.0

D 50-59% 1.0

F Below 50 0.0

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SCHEDULE AND TOPICS (NOTE - CP = COURSE PACK)

DATE TOPICS AND ASSESSMENTS REQUIRED READINGS

Module 1: September 9

Module I: Introductory Class

Introductions, Course Overture, Syllabus Review

Read: Suffield Chapter 1

Introductions, course overview, class discussion

Module 2: September

11, 16, 18

Module II: Collective Bargaining Overview

A. Definitions and Terms B. Unionization

a) Historical Context b) The Union Decision c) Process d) Structure

C. Comparison of Objectives and Strategies D. Obtaining Collective Bargaining Rights

E. The Collective Bargaining Agreement Provisions; C/B Agreements, Samples

Read:

Suffield Ch 3, 4, 5, 6, 7

-Lecture, Case Analysis, Group

Discussion

Module 3: September

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Module III: Administration - Industrial Relations (IR)

vs. Human Resources (HR) A. Industrial Relations Perspective B. Human Resource Perspective C. Harmonizing IR and HR Perspectives

Read: Text – Suffield Ch 1; CP – Gunderson (pp 133-154);

Carrell (pp 33-34); Boleman (pp 1-26) Hand-

out (Let’s Talk)

Lecture, Video; Case Study

Module 4: September

25, 30

Module IV: Factors Impacting the Collective Bargaining Contract

A. The Environment - Economic, Social, Political & Legal

B. Legal Framework Imposed on Negotiations

C. Employment Contract

Written Assignment #1- Due Wednesday, Sept 25

Read: Suffield Ch 2

CP – Gunderson (pp 155-208)

Hand-out-MB Labour Rel. Act;

Case Study 93 (Union…SGA -Lecture, Individual Reflection

Exercises, Group Discussion

Module 5: Oct 2,7, 9

Module V: Administration of the Collective Bargaining Contract

A. Traditional Grievance & Arbitration Process

B. Non-Traditional 1) Framework of Fairness 2)Informal Dispute Resolution

3)Union-Management Committees

Read: Suffield Ch 9, CP - Cloke &

Goldsmith (pp 57-132); Riox & Redekop (pp 387-

443)

-Lecture, Video, Grievance Arbitration Exercises and Role

plays

Module 6: Oct 16, 21,

23, 28

Module VI: Bargaining Processes A. Negotiation -

1) Distributive Negotiation 2) Integrative Negotiation 3) Principled Negotiation

Read: Suffield, Ch 8 ( pp 221-230) & Ch 10; CP – Lewicki (pp

243-313), Moore (315-386), Riox (444-484)

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B. Third-Party Intervention 1) Mediation 2) Arbitration 3) Other – Conciliation; Med-Arb; Arb-Med

Written Assignment #2- Due Wednesday, Oct 16

*Mid-term Exam – Wednesday, Oct 23

Lecture, Video; Negotiation &

Role-Play Exercises, In-Class time (Oct 28) for Group

Assignment #3 preparation - Negotiation Simulation

Module 7 Oct 30, Nov

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Module VII: Negotiating Collective Agreements

A. Negotiation of the Collective Bargaining Contract

1) Union-Management Relationship 2) Contract Negotiation – (Process)

B. Contract Dispute Resolution

Read:

Suffield Ch 8 (pp 205-220); Ch 10 & Ch 10 Appendix

(refer to CP- Lewicki, Moore) Lecture, Case analysis,

collective bargaining contract exercises, simulations; Group

simulation in-class time

Nov 6 Assignment #3 Group Simulations - Wednesday, Nov 6

Group Simulation

Presentations

November 13 Group Project Work Period –Wednesday, Nov 13 -

Module 8: Nov 18, 20

Module VIII: Collective Bargaining and Administration

– Special Issues A. Employee Involvement B. Public-Sector Collective Bargaining C. Comparing the Canadian Collective Bargaining

System with Other National Systems Presentation Outline Due Nov 18 (Optional)

Read:

Suffield Ch 11 CP-Gunderson (pp 210-

227&, ; Carrell & Heavrin; (pp 33-55) J Budd (pp 27-

31)

Lecture, Reflection Exercise, Group Discussion

Nov 25, 27 & Dec 2

Group Project Presentations – Nov 25, 27, Dec 2

Written Reports - Due Monday, Dec 2

Group Presentations

Dec 4

Final Class – Course Review, Final Remarks

Hand-out, Material Review, Q/A Period

-

Final Exam – Date TBA -

*The course schedule may vary as the course progresses and as student interests interact with course material.

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Academic Regulations

Students are encouraged to contact Accessibility Services at 474-6213 or the instructor should special

arrangements need to be made to meet course requirements. For further information please visit

http://umanitoba.ca/student/saa/accessibility/

University Email Policy

Effective September 1, 2013, the U of M will only use your university email account for official

communications, including messages from your instructors, department or faculty, academic advisors,

and other administrative offices. If you have not already been doing so, please send all emails from your

UofM email account. Remember to include your full name, student number and faculty in all

correspondence.

For more information visit: http://umanitoba.ca/registrar/e-mail_policy

Deferred Exams

For all students who have been approved by their faculty office to have a deferred exam:

Effective September 2005, the Department of Business Administration has instituted a policy which

provides ONE DATE ONLY for students who have deferred their final exams.

The deferred final exam date has been pre-set for Friday, January 17, 2014 at 1:00 p.m. The room

is to be determined. This does not apply to take home final exams.

Please refer to University of Manitoba’s Policy 1305 – Exam Regulations

(http://umanitoba.ca/admin/governance/governing_documents/academic/454.htm) or the Undergraduate

Program Office for rules and regulations concerning deferred exams.

Unclaimed Assignments

Pursuant to the FIPPA Review Committee’s approved recommendations as of August 15, 2007, all

unclaimed student assignments will become the property of the faculty and will be subject to destruction

six months after the completion of any given academic term.

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Academic Integrity

It is critical to the reputation of the Asper School of Business and of our degrees, that everyone

associated with our faculty behave with the highest academic integrity. As the faculty that helps create

business and government leaders, we have a special obligation to ensure that our ethical standards are

beyond reproach. Any dishonesty in our academic transactions violates this trust. Section 8 of the

University Policies, found in The University of Manitoba Calendar, addresses the issue of academic

dishonesty. Specifically, acts of academic dishonesty include, but are not limited to:

- using the exact words of a published or unpublished author without quotation marks and without

referencing the source of these words

- duplicating a table, graph or diagram, in whole or in part, without referencing the source

- paraphrasing the conceptual framework, research design, interpretation, or any other ideas of

another person, whether written or verbal (e.g., personal communications, ideas from a verbal

presentation) without referencing the source

- copying the answers of another student in any test, examination, or take-home assignment

- providing answers to another student in any test, examination, or take-home assignment

- taking any unauthorized materials into an examination or term test (crib notes)

- impersonating another student or allowing another person to impersonate oneself for the purpose of

submitting academic work or writing any test or examination

- stealing or mutilating library materials

- accessing test prior to the time and date of the sitting

- changing name or answer(s) on a test after that test has been graded and returned

- submitting the same paper or portions thereof for more than one assignment, without discussions

with the instructors involved

Group Projects and Group Work

Many courses in the Asper School of Business require group projects. Students should be aware

that group projects are subject to the same rules regarding academic dishonesty. Because of the unique

nature of group projects, all group members should exercise special care to ensure that the group project

does not violate the policy on Academic Integrity. Should a violation occur, group members are jointly

accountable unless the violation can be attributed to a specific individual(s).

Some courses, while not requiring group projects, encourage students to work together in groups (or

at least do not prohibit it) before submitting individual assignments. Students are encouraged to discuss this

issue as it relates to academic integrity with their instructor to avoid violating this policy.

In the Asper School of Business, all suspected cases of academic dishonesty are passed to the

Dean's office in order to ensure consistency of treatment.

/pkt

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University of Manitoba I.H. ASPER SCHOOL OF BUSINESS

MEDICAL ABSENTEEISM FORM

STUDENT IDENTIFICATION: (PLEASE PRINT CLEARLY)

_____________________ _______________ ___________ _______________________________

Last Name First Name Middle Initial U of M Student Identification Number

_________________________________ ________________________________________

Course # Instructor Name

________________________________ _______________________________

Student’s Signature Date

TO BE COMPLETED BY THE ATTENDING PHYSICIAN: (after the above section is completed)

(PLEASE PRINT CLEARLY)

___________________________________ _________________________________ ___________

Physician’s Last Name Physician’s First Name Middle Initial

__________________________________ _________________________________ ___________

Street Address City, Province Postal Code

________________________ ________________________

Telephone Number Fax Number

To the attention of the physician: Your evaluation of the student’s condition is being used for the

purpose of determining whether or not the student has a valid reason to miss an important exam or

assignment. Your professional evaluation is necessary to ensure that only valid cases are excused.

I certify that the nature of the student’s condition is severe enough to prevent the student from

taking an exam or completing an assignment. If requested, my associates or I will verify for

the above named instructor/administrator that this information is accurate.

The student’s condition will likely span the following dates:

______________________________ until _______________________________

(Indicate start date) (Indicate end date)

______________________________ ______________________________

Physician’s Signature Date

NOTES TO PHYSICIAN:

Please make a note in the student/patient’s file indicating that the student has given the above named

instructor/administrator permission to verify with you, your staff, or your colleagues, that the information

contained on this form is correct. Thank you for your professional evaluation of this student’s condition.

PLEASE ATTACH THIS FORM TO YOUR REGULAR OFFICE STATIONERY THAT INDICATES THE STUDENT VISITED

YOUR OFFICE.

NOTES TO STUDENT:

The use of this form is at the option of the student. However, in order to obtain an excused absence for an

assignment or exam the student must obtain a doctor’s certification that the student’s condition is severe enough

to prevent the student from taking the exam or completing the assignment.

It is NOT SUFFICIENT to provide a note that only indicates the student visited the doctor’s office.