Use this form to officially notify the Office of the Chancellor of an upcoming absence. You must have JavaScript enabled to use this form. Full Name * Email Address * Immediate Supervisor's E-mail Address * Additional person to be notified (e-mail address) An anticipated absence Rescinding an absence previously reported Updating information previously submitted regarding an absence Other... What are you reporting? Other... Absence Begin Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20242025202620272028 Absence End Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20242025202620272028 This should be the last date that you will be out, not the first day that you return. Vacation Business Travel Sick Leave Jury Duty Other... Type of absence Other... Description/Reason Please provide any further descriptive information that may be necessary. Additional Comments Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. reCAPTCHA response
