Department of Neurology

Faculty Leave & Clinic Schedule Change Request


Please fill out the following Leave Request form. A copy of the UF Leave Application will be prepared by Polly Glattli and routed to you for signature.

If travel expenses are being requested, please complete the Neurology Request for Travel Approval form and mail to your Department Accountant:

Ann Clemons
PO Box 100236

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Name:

Type of Leave:

Begin Date: - -      Time:

End Date: - -      Time:

Total Hours:

Clinic Schedule changed?:

Are you on Call: * Yes No
* If so, who will cover you:

Clinic Covered by (Type name):

Are Travel Expenses Required: Yes No

Purpose of Schedule Change:

University of Florida Location: http://www.neurology.ufl.edu
Updated: , © 2007 University of Florida