Home » Clinic Make-Up Shift Request Form
Please enter your information below. Please ensure your email address is correct as confirmations will be sent to the email address you submit in the form.
Please enter your first name
Please enter your last name
Please enter a valid phone number
Please enter an @pacificcollege.edu email address
Please select a campus
Please enter the information for the shift you missed below.
Please select a clinic level
Please select a term
Please enter a date
Please select a missed shift clinic level
Please select a time
Please enter a supervisor’s name
Please enter a reason for missing shift
Pick date that will allow for at least 5 BUSINESS days to process
Please select a valid time
Please pick a different clinic shift than your second or third choice
Please pick a different clinic shift than your first or third choice
Please pick a different clinic shift than your first or second choice
Please check the box to confirm
Submit
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