Leave Request

Leave Request

Employee Name*

Select or enter value

Employee Type*

Select

Leave Type Requested*

Select

Please elaborate on the change or cancelation in the comment box.

Begin Leave*

End Leave*

Partial Day - Begin Time

Please enter time as H:MM (ex: 1:00 PM = 1:00)

Partial Day - End Time

Please enter time as H:MM (ex: 1:00 PM = 1:00)

Leave Hours*

Sick Leave - Information*

What is the nature of your sick leave? (illness, medical appointment, etc.)

For more than 3 consecutive days of sick leave, you should reach out to HR for Family Medical Leave.

Sick Leave - Appointment Time

Compensatory Time - Type*

Select state if actual hours worked do not add up to 40 for the week in question.

Select federal if actual hours worked add up to 40 for the week in question.

Select

Bereavement - Relationship*

Relationship to the bereaved.

Select

Bereavement - Name*

Name of the bereaved.

Emergency Leave and Leave without Pay - Info*

Nature of Emergency Leave requested and/or justification for Leave without Pay.

Travel Destination*

Where are you traveling (City, State)?

Travel Purpose*

Why are you traveling? If you're traveling to a conference, what conference and what is your role at the conference?

Acting Chair/Director*

Who will be your acting Chair/Director?

Faculty Information*

How will your classes be covered during this time period? Please answer "N/A" if you won't have classes during this time period.

Comment

Leave any additional comments you may have here.

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