Faculty Absence Reporting Form

Faculty members are required to notify their departments in advance of absences that will take them away from their classes or other regular duties at the University. Faculty Policies and Procedures requires that prior permission be received from the chancellor or the dean. The Medical School Dean has delegated the responsibility for approval of absences to the departmental Chairs. For purposes of accountability to the University and the State, it is important that all faculty members file the following form with the department Chair in advance of foreseeable absences. Needless to say, absences caused by illness or mishap can only be reported retrospectively.
Please give this form to the department Chair at least 10 working days prior to your anticipated absence. The Chair will respond within 5 days if the absence is not approved.

Your Name(required):
Your Email(required):
Subject :
Date Leaving (MM/DD/YY):
Date Returning (MM/DD/YY):
Total number of days counted as vacation:
Total number of days counted as Outside activity related to university duties (e.g., consulting):
Please fill in the specific location you can be reached while you are away including phone number. :

Select who will be assuming your duties while you are away.: