Emergency Leave Request Form

Emergency Leave Request Form

Employee Type

Faculty or Staff

Student Worker

Unfortunately, Emergency Leave requirements exclude an employee in a position for which student status is a requirement for employment.

Employment Status applicable?

Have you been in a budgeted position appointed for 50 % or more time for a period of at least 4 1/2 months?

Yes

Unfortunately, Emergency Leave requirements exclude an employee NOT in a budgeted position NOR appointed for at leaset 50 % or more time for a period of at least four and one-half months.

UIN

Employee Name*

Employee Email Address*

This field requires a complete email address for you.

Department*

Select from the drop down list provided

Select

Manager Email Address*

This field requires a complete email address for your manager.

Reason for Request

Leave Date(s) Request Begin:

Leave Date Requested Ending

Total Hours Requested

Comments:

File Upload

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