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Chemical and NanoEngineering Department Leave Request Form
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Email
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Record my email address with my response
Leave of Absence Request
This section will be used for internal approval of your leave. You will receive a notification when your leave of absence has been approved.
First Name:
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Your answer
Last Name:
*
Your answer
Leave start
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MM
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DD
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YYYY
Leave end
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MM
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DD
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YYYY
Reason for Absence:
*
Your answer
Name of conference (if applicable):
Your answer
Are you travelling internationally?
*
Yes
No
Phone number where you may be reached if needed:
*
Your answer
Address where you may be reached if needed:
*
Your answer
Reimbursement Information
Please enter all information needed to get your travel event set up for reimbursement.
Traveling from:
Your answer
Traveling to:
Your answer
Reimbursement Project-Task:
Your answer
Estimated expenses:
Your answer
Teaching
Are you scheduled to teach during this period?
*
Yes
No
If yes, arrangements made for courses:
If leave is during finals week, justification must be attached, including the name of the faculty member who will administer the exam and arrangements for turning in final grades.
Your answer
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