Orthopaedics Faculty Leave Request

Please submit a separate form for each month when a requested leave period overlaps multiple months.  (Example: Faculty wants to take off July 12 & 31 and August 1 & 8, fill out 2 forms, one for July and 1 for August.) Non-clinical faculty, select Yes to Question 1 regarding 35 day notice and N/A in Clinic Location. 

If you wish to keep a copy for your records, after filling out the form, 

please print the form from your browser menu before pressing the Submit button. 

IF CHANGES ARE NEEDED AFTER THE FORM IS SUBMITTED, PLEASE SEND EMAIL TO Rosemary & JoDeAnn.

Dates of leave for clinic selection 1
Dates of leave for clinic selection 1
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