Faculty Leave Request

Faculty Leave Request Form

LEAVE INFORMATION

Name(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY

CLINIC CANCELLATION INFORMATION

*Cancellations <30 days = emergency only & require Chief approval
*Cancellations 30-60 day window = require makeup clinics
*Cancellations >60 days = follows annual Division cancellation allotment
*Admin staff will follow up with you via e-mail regarding scheduled makeup clinics.

ACADEMIC LEAVE INFORMATION

MM slash DD slash YYYY
MM slash DD slash YYYY