Leave Request LEAVE INFORMATIONName (First, Last)(Required) First Employee Type(Required)FacultyFellowTransplant FellowAPPStaffSupervisor(Required)Palvi SharmaAmir KazoryAlfonso SantosDavid WeinerAzra BihoracWei ShaoPinaki SarderJuan Manual Aranda-AmadorBenjamin ShickelBrooke ArmfieldDivya VellankiAhmed NaglahTezcan Ozrazgat BaslantiMark SegalAnindya Sankar PaulElizabeth Ann Nason PalmerAbdel AlliKyle ChambersUFID(Required)Total Number of Hours Requested (1 day=8 hours)(Required)Leave Start Date(Required) MM slash DD slash YYYY Leave End Date(Required) MM slash DD slash YYYY Select Type of Leave:(Required)VacationSickAcademicFMLALeave without PayOther (Please provide details in comments)Comments:CLINIC CANCELLATION INFORMATION*Cancellations <30 days = emergency only & require Chief approval *Cancellations 30-60 day window = require makeup clinics *Cancellations >60 days = follows annual Division cancellation allotment Does this require clinic cancellation?(Required)N/AYesNoIf YES, what dates require clinic cancellation? Indicate AM/PM/both and Who/EPIC coverage each date.If indicated, provide several dates/times for makeup clinics (within +/- 2 weeks of cancelled clinics).Once Chief approval is received, you must also follow up with the clinic to ensure appropriate closures/make-ups have been scheduled. Signature(Required)Disclaimer: If it is Academic Travel, please contact Neph Fiscal for UFGO.
