New Mexico State University College of Education Request for Leave of Absence
Email address *
Name *
Your answer
Department *
Your answer
Type of Leave
Beginning Leave Date
MM
/
DD
/
YYYY
Beginning Leave Time
Time
:
Ending Leave Date
MM
/
DD
/
YYYY
Ending Leave Time
Time
:
For a total of: *
Day
Days
In case of emergency, I can be reached at (Phone):
Your answer
Date of Request
MM
/
DD
/
YYYY
Additional Comments
Your answer
For administrators, indicate person assuming administrative responsibility during your absence:
Your answer
Acting administrator can be reached at (Phone):
Your answer
For Administrative Use:
Approval of Dean/Department Head/Supervisor:
A copy of your responses will be emailed to the address you provided.
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