Non Clinical Faculty Leave Request

LEAVE INFORMATION
Name*
First Last
Email*
UFID*
Leave Start Date*
MM slash DD slash YYYY
Date Returning to Work*
MM slash DD slash YYYY
Total Number of Hours Requested*
Select Type of Leave:*
If this is a regarding a new FMLA event that has not been approved, please submit the initial intake form at https://benefits.hr.ufl.edu/time-away/fmla/fmla-preliminary-request-form/
ACADEMIC LEAVE INFORMATION
Select Type of Academic Leave:
Will the conference require a division reimbursement?
Name of Conference:
Start Date:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Required Signatures
Signature*
CAPTCHA

LEAVE INFORMATION