University of Wisconsin Medical School Faculty Absence Reporting Form

Faculty members are required to notify their departmetns in advance of absences that will take them away from their "classes or other regular duties at the University." Faculty Policies and Procedures requires that prior permission be received from the chancellor or the dean. The Medical School Dean has delegated the responsibitily for approval of absences to departmental Chairs. For purposes of accountability to the University and State it is important that all faculty members file the following form with the department Chair in advance of forseeable absences.

QUICK LINKS: [Medical Physics Home Page]

Use Submit Form to submit a request. Use Reset Form to clear/reset the form.

Name:
Dates of anticipated absence:
from (select month, day)   
  to (select month, day)   

Reason for Absence: 
(select) 
If partially or totally work related, please indicate the activity:
(select) 

General Description of activity: (e.g., "Attend AAPM Meeting, Honolulu")
 

Location and telephone where can you be reached: