USC Radiology - Request For Time-Off

In order to process your Request for Time-Off, you will need to complete the following form. PLEASE USE YOUR MED.USC.EDU email address. If the RTO is not complete, the form will be returned. Once filled out appropriately, it will be submited to Division Head for approval. The response will be forwarded electronically to faculty/fellow.
Your Email Address: *
Your answer
Support Staff Email: *
Your answer
Full Name (first, last): *
Your answer
Designation:
Division: *
RTO Type: *
RTO benefit to the department:
Your answer
For Academic, CME, Departmental or Grant Leaves: Provide which Meeting, Title of the Presentation, and Location:
Your answer
Dates Requested (from): *
MM
/
DD
/
YYYY
Dates Requested (until): *
MM
/
DD
/
YYYY
Total Days requested:
Your answer
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