H1N1 Reporting Form
  • H1N1 Reporting Form

Tracking Student Absences Due to the H1N1 Flu

In an effort to track student absences that are related to the H1N1 Flu, Suffolk University students may voluntarily report flu-related absences by completing this on-line form. Information submitted through this form will be received by the Student Affairs Office and may be released to University personnel and state/federal agencies for reporting purposes. Providing your name is optional; however, the University is better able to communicate with you and respond to your needs if we have your name.

Submitting your absence through this form should not be construed as an appropriate substitution for regular absence reporting procedures. You are still required to report any absences directly to your professors.

If you have questions regarding your medical care, you are advised to contact your primary health care provider.

Please note: Information submitted via this form is not sent over a secure line. Please visit the University’s Internet Privacy Policy for more information.

* Indicates a required field.

First Name:
Middle Initial:
Last Name:
*Email:
*Where do you live when in school?
I am currrently studying abroad:
*Reason for absence:
*While absent, where are you staying?
*When do you anticipate returning to classes?
Month:
Date:
Notes:

Please contact the Student Affairs Office if you would like information about campus resources that may be helpful to you upon your return to campus. A staff member will respond by email.