Academic Affairs Reassigned Time Request Form

First Name *

Last Name *

LuNum *

Ex. LXXXXXXXX

Rank *

Professor

Associate Professor

Assistant Professor

Instructor

Department *

Telephone *

Phone

Email *

Semester: *

Fall 2025

Spring 2026

Are you requesting reassigned time for Academic Year 2025-2026? *

No

Yes

*

Send me a copy of my responses