Campus Absence Form

This form must be completed for any absence from campus, including vacation time, sick leave and university related business absences that is not part of routine day-to-day assignments.

Vacation Requests Please complete this form as far in advance of your absence as possible. The form must be approved by the Dean of Student Development and Academic Services before your absence.
Sick Leave  For unexpected personal absences covered by sick leave hours, the form must be completed within one week of your return to campus.
University-related Business For university related business, the form must be approved by the Dean of Student Development and Academic Services before your absence. This form need not be filed for travel and absences from campus that are part of routine day-to-day assignments. Questions should be discussed with the Dean.

What is your name?     Department:  Upward Bound/Student Development & Academic Services

What is the purpose of your absence?   Vacation   Business (detail below):

Purpose of business absence: 

What DATE will your absence begin? (mm/dd/yyyy)     What TIME will your absence begin? (hh:mm)    AM  PM

What DATE will your absence end? (mm/dd/yyyy)     What TIME will your absence end? (hh:mm)    AM  PM

Address at which you can be reached during absence: 

Phone number(s) at which you can be reached during absence (xxx-xxx-xxxx)  #1       #2 

What arrangements have you made to cover your responsibilities during your absence?

Source of funds for travel:  Personal     University - amount:  $ 

Mode of travel:  Personal (vacation)     Biz-Air    Biz-Train    Biz-Personal Car     Biz-Enterprise    Biz-UW-L Fleet  

  

After you submit this form, you will receive an email from Antoiwana.