Notice Advanced Accounting Textbook & User's Guide Manuals
ACC 3030
Winter 2014
University of Manitoba
I.H. Asper School of Business
Department of Accounting and Finance
ACC 3030 (A01) - Advanced Financial Accounting
Course Outline
Winter 2014
Tuesday/Thursday, 11:30AM – 12:45PM, Tier 215
Instructor:
Office:
Phone #:
E-mail:
Office Hours:
Mingzhi Liu
460 Drake
204-474-6847
mingzhi.liu@ad.umanitoba.ca
Thursday, 2:00PM – 4:00PM or by appointment
To access course website use the address https://www.umanitoba.ca/d2l to log
on. Then click the ACC3030 course title.
Course Objectives
The course builds on technical skills and conceptual understanding developed in earlier courses,
particularly ACC 2010 and ACC 2020. Its primary focus is on accounting for long-term intercorporate investments, particularly methods of consolidation accounting; but there is also
coverage of accounting for foreign currency transactions and accounting for non-for-profit
organizations. At the conclusion of this course you will be expected to have developed:
1.
2.
3.
technical and procedural skills required to deal with the topics listed above;
the ability to apply conceptual principles when selecting appropriate accounting policies
in different circumstances; and
the ability to assess a situation, identify issues and alternatives, and formulate
recommendations using professional judgment.
Required Text
Hilton and Herauf, 2013, Modern Advanced Accounting in Canada (7th edition) published by
McGraw-Hill Ryerson Ltd. Canada (refer to Bookstore for the details). The eConnect code is
required for online assignments. Information on accessing eConnect for this course will be
posted on the course website (D2L).
1|Page
ACC 3030
Winter 2014
CICA Handbook and IFRS, made available on The University of Manitoba Libraries Website by
Canadian Institute of Chartered Accountants, see below for accessing such data.
The CICA Handbook on the University of Manitoba Libraries Website
The CICA Handbook is available in electronic format on the University of Manitoba Libraries
website. To access the Handbook:
1.
From the University of Manitoba homepage (umanitoba.ca), click on LIBRARIES
under RESOURCES block.
2.
Click on ARTICLES & DATABASES under FIND block.
3.
You should see the page ARICLES & DATABASES A-Z (A). Click on C. Scroll
down to click on 2 to see CICA STANDARDS & GUIDANCE COLLECTION listed
as the 2nd item.
4.
Click on CICA STANDARDS & GUIDANCE COLLECTION.
5.
You will then have to enter your Library ID and PIN (if you do not know your
Library ID and/or PIN, there is a link on this page that will help you) and click on
Login.
6.
On the Knotia.ca page, click on CICA Standards & Guidance Collection.
7.
The most efficient way to access a particular section in the Handbook is to enter the
section number in the “Fetch” box on the left-hand side of the screen and click on Go.
The Handbook is accessible on campus or from off-campus with an internet connection.
The CICA Handbook subscription is provided by the Institute of Chartered Accountants of
Manitoba.
Conduct of the Course
The course will be conducted principally as a lecture-style class, with some in-class discussion
and activities involving the application of accounting principles. Readings, as indicated in the
tentative class schedule below, have been selected and assigned for each topic covered in the
course. The readings will be most effective if completed prior to class. Solutions for
problems and cases from the textbook will be available in class or through the course website
(D2L).
Online Assignments
Assignments will be created for practice and course credit through eConnect (refer to
“eConnect Instructions” available on D2L for registration guidance). There will be 10
assignments and a 1.2% course credit will be given for each assignment completed by midnight
of the due date specified below (the maximum credit for assignment is 10%).
Assignment
1 / Chp. 2
2 / Chp. 3
3 / Chp. 4
4 / Chp. 5
5 / Chp. 6-7
2|Page
Due by 11:59 PM on
Sunday, January 19
Sunday, January 19
Sunday, January 26
Sunday, February 2
Sunday, February 23
Assignment
6 / Chp. 8
7 / Chp. 9
8 / Chp. 10
9 / Chp. 11
10 / Chp. 12
Due by 11:59 PM on
Sunday, March 9
Sunday, March 16
Sunday, March 16
Sunday, March 30
Sunday, April 6
ACC 3030
Winter 2014
Allocation of Grades
Online Assignment:
Midterm Examination One:
Midterm Examination Two:
Final Examination:
Through eConnect
Thursday February 6, 2014 6pm-9pm
Thursday March 20, 2014 6pm-9pm
To be determined by the Registrar’s Office
10%
20%
30%
40%
100%
Examinations
For any examination, each student will be allowed to bring calculators (non-programmable and
without text storage capacity), erasers, pens and pencils. No other materials will be permitted.
Conflicts with employers do not qualify as legitimate reasons to miss any examination.
A grade of zero will be given to a missed midterm examination without a legitimate reason.
Students who miss a midterm examination for a legitimate reason (medical, compassionate,
academic conflict or university sports team travel) should inform me with suitable
documentation within 5 days of the missed examination to have the weight of the missed
midterm added to the final examination.
In order to obtain an excused medical absence for an 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 test. It is recommended that the student ask the doctor filled out the Medical
Absenteeism Form attached to this course outline as the suitable documentation for an excused
medical absence. It is NOT SUFFICIENT to provide a note that only indicates the student
visited the doctor’s office.
Students who miss the final examination must apply to the Undergraduate Program Office in
their faculty for possible deferred examination privileges. Successful applicants will be
informed the time and location of the deferred final examination at time of application.
In order to obtain an excused medical absence for a test or midterm 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 test. It is recommended that the student ask the doctor to fill out the
Medical Absenteeism Form attached to the course outline as suitable documentation for an
excused medical absence. It is NOT SUFFICIENT to provide a note that only indicates the
student visited the doctor’s office.
Bonus Marks
Additional questions may be distributed in class or assigned as homework for extra marks toward
your course grade, to a maximum of 5%.
3|Page
ACC 3030
Winter 2014
Class Schedule
Date
Topic
Course Introduction
Financial Instruments
Jan 9
Financial Instruments
Jan 14
Intercorporate Investments
Jan 16
Intercorporate Investments
Jan 21
Consolidation on Date of Acquisition
Jan 23
Consolidation on Date of Acquisition
Jan 28
Consolidation subsequent to acquisition
Jan 30
Consolidation subsequent to acquisition
Feb 4
Intercompany Transactions
Feb 6
No Class - Midterm 1 Chapters 2-5
Feb 11
Intercompany Transactions
Feb 13
Intercompany Transactions
Feb 18/20 No Classes – Reading Week
Jan 7
Feb 25
Ownership Issues
Feb 27
Ownership Issues
Mar 4
Ownership Issues
Mar 6
Other Reporting Issues
Mar 11
Mar 13
Mar 18
Mar 20
Mar 25
Mar 27
Apr 1
Apr 3
Apr 8
TBA
4|Page
Foreign currency translation and hedge
accounting
Foreign currency translation and hedge
accounting
Translation and consolidation of foreign
subsidiaries
No Class – Midterm 2 Chapters 2-10
Translation and consolidation of foreign
subsidiaries
Translation and consolidation of foreign
subsidiaries
NFP Accounting
NFP Accounting
Review
Final Exam Chapters 2-12
Readings
Chapter 2
Chapter 2
Chapter 3
Chapter 3
Chapter 4
Chapter 4
Chapter 5
Chapter 5
Chapter 6 and 7A (omit 7B)
Chapter 6 and 7A (omit 7B)
Chapter 6 and 7A (omit 7B)
Chapter 8 (omit LO1 Pages
423-426)
Chapter 8 (omit LO1 Pages
423-426)
Chapter 8 (omit LO1 Pages
423-426)
Chapter 9 (omit LO3-4
pages 512-523)
Chapter 10
Chapter 10
Chapter 11
Chapter 11
Chapter 11
Chapter 12
Chapter 12
ACC 3030
Winter 2014
ACC3030 Textbook Questions
Chapter
In Class Exercise*
Homework
2
Problems: 4, 5
Problems: 1, 2, 3, 6, 7
3
Case: 1; Problems: 3, 9, 10
Problems: 1, 2, 5, 6, 11, 12
4
Problems: 2, 3, 7a
Case: 1; Problems: 1, 4, 6, 9, 10, 11
5
Problems: 6, 10, 13
Problems: 1, 4, 5, 7, 8, 11, 14
6
Problems: 7, 15
Problems: 1, 2, 3, 5, 10, 12, 14
7
Problems: 13, 15, 17
Problems: 1,2, 4, 6, 9
8
Problems: 11, 16
Problems: 2, 3, 5, 7, 10, 12, 18
9
Problem: 15
Problems: 9, 10, 13
10
Problems: 10, 13
Problems: 1, 2, 3, 7, 9, 11, 15
11
Problems: 4, 11
Problems: 1, 2, 6, 8, 10, 13
12
Problems: 10, 11
Problems: 1, 2, 4, 6, 8, 12
*subject to change; preview the chapter and read the assigned in-class exercise
before each class will maximize your benefit of attending class.
5|Page
ACC 3030
Winter 2014
Academic Integrity
It is critical to the reputation of the I. H. Asper School of Business and of our degrees, that
everyone associated with our faculty behaves 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. The University of Manitoba Undergraduate Calendar addresses the issue of academic
dishonesty under the heading “Plagiarism and Cheating.” 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 tests 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 I. H. 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 insure 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 related to academic integrity with their instructor to avoid violating this
policy.
In the I. H. Asper School of Business, all suspected cases of academic dishonesty are passed to the
Dean’s office in order to ensure consistency of treatment.
6|Page
ACC 3030
Attachment 2
UNIVERSITY OF MANITOBA
Faculty of Management
Medical Absenteeism Form
Student Identification: (please print clearly)
______________________________
Last Name
___________________ ___________ _______________________________
First Name
Middle Initial U of M Student Identification Number
I hereby authorize ________________________________ to verify with the attending physician or his/her
(Name of Instructor/Administrator)
staff or colleagues that the contents of this form are true.
________________________________________
Student’s Signature
_______________________________________
Date
To be completed by the attending physician: (after the above section is completed)
________________________________________
Physician’s Last Name (please print clearly)
______________________________ ________________
Physician’s First Name
Middle Initial
___________________________________________
Street Address
________________________________
City, Province
___________________________________________
Telephone Number
_________________________________
Fax Number
__________________
Postal Code
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:
___________________________________
Physician’s Signature
____________________________
(indicate start date)
until ____________________________
(indicate end date)
_________________________________
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.
Note 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.
7|Page
Winter 2014
University of Manitoba
I.H. Asper School of Business
Department of Accounting and Finance
ACC 3030 (A01) - Advanced Financial Accounting
Course Outline
Winter 2014
Tuesday/Thursday, 11:30AM – 12:45PM, Tier 215
Instructor:
Office:
Phone #:
E-mail:
Office Hours:
Mingzhi Liu
460 Drake
204-474-6847
mingzhi.liu@ad.umanitoba.ca
Thursday, 2:00PM – 4:00PM or by appointment
To access course website use the address https://www.umanitoba.ca/d2l to log
on. Then click the ACC3030 course title.
Course Objectives
The course builds on technical skills and conceptual understanding developed in earlier courses,
particularly ACC 2010 and ACC 2020. Its primary focus is on accounting for long-term intercorporate investments, particularly methods of consolidation accounting; but there is also
coverage of accounting for foreign currency transactions and accounting for non-for-profit
organizations. At the conclusion of this course you will be expected to have developed:
1.
2.
3.
technical and procedural skills required to deal with the topics listed above;
the ability to apply conceptual principles when selecting appropriate accounting policies
in different circumstances; and
the ability to assess a situation, identify issues and alternatives, and formulate
recommendations using professional judgment.
Required Text
Hilton and Herauf, 2013, Modern Advanced Accounting in Canada (7th edition) published by
McGraw-Hill Ryerson Ltd. Canada (refer to Bookstore for the details). The eConnect code is
required for online assignments. Information on accessing eConnect for this course will be
posted on the course website (D2L).
1|Page
ACC 3030
Winter 2014
CICA Handbook and IFRS, made available on The University of Manitoba Libraries Website by
Canadian Institute of Chartered Accountants, see below for accessing such data.
The CICA Handbook on the University of Manitoba Libraries Website
The CICA Handbook is available in electronic format on the University of Manitoba Libraries
website. To access the Handbook:
1.
From the University of Manitoba homepage (umanitoba.ca), click on LIBRARIES
under RESOURCES block.
2.
Click on ARTICLES & DATABASES under FIND block.
3.
You should see the page ARICLES & DATABASES A-Z (A). Click on C. Scroll
down to click on 2 to see CICA STANDARDS & GUIDANCE COLLECTION listed
as the 2nd item.
4.
Click on CICA STANDARDS & GUIDANCE COLLECTION.
5.
You will then have to enter your Library ID and PIN (if you do not know your
Library ID and/or PIN, there is a link on this page that will help you) and click on
Login.
6.
On the Knotia.ca page, click on CICA Standards & Guidance Collection.
7.
The most efficient way to access a particular section in the Handbook is to enter the
section number in the “Fetch” box on the left-hand side of the screen and click on Go.
The Handbook is accessible on campus or from off-campus with an internet connection.
The CICA Handbook subscription is provided by the Institute of Chartered Accountants of
Manitoba.
Conduct of the Course
The course will be conducted principally as a lecture-style class, with some in-class discussion
and activities involving the application of accounting principles. Readings, as indicated in the
tentative class schedule below, have been selected and assigned for each topic covered in the
course. The readings will be most effective if completed prior to class. Solutions for
problems and cases from the textbook will be available in class or through the course website
(D2L).
Online Assignments
Assignments will be created for practice and course credit through eConnect (refer to
“eConnect Instructions” available on D2L for registration guidance). There will be 10
assignments and a 1.2% course credit will be given for each assignment completed by midnight
of the due date specified below (the maximum credit for assignment is 10%).
Assignment
1 / Chp. 2
2 / Chp. 3
3 / Chp. 4
4 / Chp. 5
5 / Chp. 6-7
2|Page
Due by 11:59 PM on
Sunday, January 19
Sunday, January 19
Sunday, January 26
Sunday, February 2
Sunday, February 23
Assignment
6 / Chp. 8
7 / Chp. 9
8 / Chp. 10
9 / Chp. 11
10 / Chp. 12
Due by 11:59 PM on
Sunday, March 9
Sunday, March 16
Sunday, March 16
Sunday, March 30
Sunday, April 6
ACC 3030
Winter 2014
Allocation of Grades
Online Assignment:
Midterm Examination One:
Midterm Examination Two:
Final Examination:
Through eConnect
Thursday February 6, 2014 6pm-9pm
Thursday March 20, 2014 6pm-9pm
To be determined by the Registrar’s Office
10%
20%
30%
40%
100%
Examinations
For any examination, each student will be allowed to bring calculators (non-programmable and
without text storage capacity), erasers, pens and pencils. No other materials will be permitted.
Conflicts with employers do not qualify as legitimate reasons to miss any examination.
A grade of zero will be given to a missed midterm examination without a legitimate reason.
Students who miss a midterm examination for a legitimate reason (medical, compassionate,
academic conflict or university sports team travel) should inform me with suitable
documentation within 5 days of the missed examination to have the weight of the missed
midterm added to the final examination.
In order to obtain an excused medical absence for an 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 test. It is recommended that the student ask the doctor filled out the Medical
Absenteeism Form attached to this course outline as the suitable documentation for an excused
medical absence. It is NOT SUFFICIENT to provide a note that only indicates the student
visited the doctor’s office.
Students who miss the final examination must apply to the Undergraduate Program Office in
their faculty for possible deferred examination privileges. Successful applicants will be
informed the time and location of the deferred final examination at time of application.
In order to obtain an excused medical absence for a test or midterm 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 test. It is recommended that the student ask the doctor to fill out the
Medical Absenteeism Form attached to the course outline as suitable documentation for an
excused medical absence. It is NOT SUFFICIENT to provide a note that only indicates the
student visited the doctor’s office.
Bonus Marks
Additional questions may be distributed in class or assigned as homework for extra marks toward
your course grade, to a maximum of 5%.
3|Page
ACC 3030
Winter 2014
Class Schedule
Date
Topic
Course Introduction
Financial Instruments
Jan 9
Financial Instruments
Jan 14
Intercorporate Investments
Jan 16
Intercorporate Investments
Jan 21
Consolidation on Date of Acquisition
Jan 23
Consolidation on Date of Acquisition
Jan 28
Consolidation subsequent to acquisition
Jan 30
Consolidation subsequent to acquisition
Feb 4
Intercompany Transactions
Feb 6
No Class - Midterm 1 Chapters 2-5
Feb 11
Intercompany Transactions
Feb 13
Intercompany Transactions
Feb 18/20 No Classes – Reading Week
Jan 7
Feb 25
Ownership Issues
Feb 27
Ownership Issues
Mar 4
Ownership Issues
Mar 6
Other Reporting Issues
Mar 11
Mar 13
Mar 18
Mar 20
Mar 25
Mar 27
Apr 1
Apr 3
Apr 8
TBA
4|Page
Foreign currency translation and hedge
accounting
Foreign currency translation and hedge
accounting
Translation and consolidation of foreign
subsidiaries
No Class – Midterm 2 Chapters 2-10
Translation and consolidation of foreign
subsidiaries
Translation and consolidation of foreign
subsidiaries
NFP Accounting
NFP Accounting
Review
Final Exam Chapters 2-12
Readings
Chapter 2
Chapter 2
Chapter 3
Chapter 3
Chapter 4
Chapter 4
Chapter 5
Chapter 5
Chapter 6 and 7A (omit 7B)
Chapter 6 and 7A (omit 7B)
Chapter 6 and 7A (omit 7B)
Chapter 8 (omit LO1 Pages
423-426)
Chapter 8 (omit LO1 Pages
423-426)
Chapter 8 (omit LO1 Pages
423-426)
Chapter 9 (omit LO3-4
pages 512-523)
Chapter 10
Chapter 10
Chapter 11
Chapter 11
Chapter 11
Chapter 12
Chapter 12
ACC 3030
Winter 2014
ACC3030 Textbook Questions
Chapter
In Class Exercise*
Homework
2
Problems: 4, 5
Problems: 1, 2, 3, 6, 7
3
Case: 1; Problems: 3, 9, 10
Problems: 1, 2, 5, 6, 11, 12
4
Problems: 2, 3, 7a
Case: 1; Problems: 1, 4, 6, 9, 10, 11
5
Problems: 6, 10, 13
Problems: 1, 4, 5, 7, 8, 11, 14
6
Problems: 7, 15
Problems: 1, 2, 3, 5, 10, 12, 14
7
Problems: 13, 15, 17
Problems: 1,2, 4, 6, 9
8
Problems: 11, 16
Problems: 2, 3, 5, 7, 10, 12, 18
9
Problem: 15
Problems: 9, 10, 13
10
Problems: 10, 13
Problems: 1, 2, 3, 7, 9, 11, 15
11
Problems: 4, 11
Problems: 1, 2, 6, 8, 10, 13
12
Problems: 10, 11
Problems: 1, 2, 4, 6, 8, 12
*subject to change; preview the chapter and read the assigned in-class exercise
before each class will maximize your benefit of attending class.
5|Page
ACC 3030
Winter 2014
Academic Integrity
It is critical to the reputation of the I. H. Asper School of Business and of our degrees, that
everyone associated with our faculty behaves 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. The University of Manitoba Undergraduate Calendar addresses the issue of academic
dishonesty under the heading “Plagiarism and Cheating.” 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 tests 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 I. H. 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 insure 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 related to academic integrity with their instructor to avoid violating this
policy.
In the I. H. Asper School of Business, all suspected cases of academic dishonesty are passed to the
Dean’s office in order to ensure consistency of treatment.
6|Page
ACC 3030
Attachment 2
UNIVERSITY OF MANITOBA
Faculty of Management
Medical Absenteeism Form
Student Identification: (please print clearly)
______________________________
Last Name
___________________ ___________ _______________________________
First Name
Middle Initial U of M Student Identification Number
I hereby authorize ________________________________ to verify with the attending physician or his/her
(Name of Instructor/Administrator)
staff or colleagues that the contents of this form are true.
________________________________________
Student’s Signature
_______________________________________
Date
To be completed by the attending physician: (after the above section is completed)
________________________________________
Physician’s Last Name (please print clearly)
______________________________ ________________
Physician’s First Name
Middle Initial
___________________________________________
Street Address
________________________________
City, Province
___________________________________________
Telephone Number
_________________________________
Fax Number
__________________
Postal Code
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:
___________________________________
Physician’s Signature
____________________________
(indicate start date)
until ____________________________
(indicate end date)
_________________________________
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.
Note 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.
7|Page