Faculty Leave Form, Less than 7 Days
UNIVERSITY OF CALIFORNIA, BERKELEY DEPARTMENT OF BIOENGINEERING REQUEST FOR ACADEMIC LEAVE OF ABSENCE FOR SEVEN (7) CALENDAR DAYS OR LESS

If your leave will be 7 days or more please contact Alison Rath in 306 Stanley Hall.

Please submit this form at least one week in advance of the proposed leave. For purposes of verification, faculty members whom you designate to be in charge of your courses and student advising during your absence must forward an email confirming arrangements.
Sign in to Google to save your progress. Learn more
Your name *
First and Last Name
Email address *
Leave of absence dates. FROM date TO  date... *
Ex: May 5, 2013 - May 8, 2013
Purpose of leave *
Address where you can be reached in an emergency *
Your hotel, for example
Phone Number where you can be reached in an emergency
Courses you are teaching this semester
What courses are you teaching that may be impacted by your absence?
Days and Times of Courses, Alternative arrangements you are making.
How are you managing your absence from class?
Advising: Are you directing your students to alternate advisers while you are gone? Please name the advisers.
Who is in charge of your lab while you are away?
Please name a responsible lab contact in case of issues.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of UC Berkeley. Report Abuse
Google Forms