Leave of Absence Request — Faculty

Faculty Information
Name*
First Last
Email*
Leave Information
Leave of Absence (please select one):*
- Vacation (personal)
- Work (research, study, consultation)
If travel is required for a work leave, please fill out the Travel Authorization - Faculty form.
Departure Date*
Month
Day
Year
Return Date*
Month
Day
Year
Add additional dates
- Yes
Leave of Absence (please select one):*
- Vacation (personal)
- Work (research, study, consultation)
If travel is required for a work leave, please fill out the Travel Authorization - Faculty form.
Departure Date*
Month
Day
Year
Return Date*
Month
Day
Year
Add additional dates
- Yes
Leave of Absence (please select one):*
- Vacation (personal)
- Work (research, study, consultation)
If travel is required for a work leave, please fill out the Travel Authorization - Faculty form.
Departure Date*
Month
Day
Year
Return Date*
Month
Day
Year
Additional notes to provide the Dean (optional)

Faculty Information