Leave Request Form Leave Request Name First Last Faculty/Clinician Email* Type of Leave*Annual LeaveSick LeaveProfessional/EducationalDecember Personal LeaveBegin Date* Begin Time : HH MM AM PM End Date* End Time : HH MM AM PM Number of Total Leave Hours*Please enter a number from 0 to 99.Total Hours Absent from Work*Please enter a number from 0 to 99.Clinic Scheduled Day?* Yes No Not a regular clinic day Are you on service?*YesNoTotal Sessions Absent from ClinicPlease enter a number from 0 to 99.Please indicate absence in number of clinic sessions missed. A clinic is 4 hours long so one missing clinic = 1 session, missing 2 hours of a four hour clinic = .5 session.If yes, who will cover you?Clinic NamePurpose of Schedule ChangeAre Travel & Expenses required?*YesNo This iframe contains the logic required to handle Ajax powered Gravity Forms.