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UNIVERSITY OF CALIFORNIA, BERKELEY DEPARTMENT OF BIOENGINEERING

REQUEST FOR ACADEMIC LEAVE OF ABSENCE FOR SEVEN (7) CALENDAR DAYS OR LESS

If your leave will be 7 days or more please contact Alison Rath in 306 Stanley Hall.

Please submit this form at least one week in advance of the proposed leave. For purposes of verification, faculty members whom you designate to be in charge  of your courses and student advising during your absence must forward an email confirming arrangements.

No URLs will be accepted in this form, due to spam-prevention issues.
 

Name:        
    Today's Date:      

 

Leave of absence dates
    From:         To:      

 

Purpose of Leave
    (name of conference/meeting/date/location/title of paper)
     

 

Where can you be reached in an emergency?
    Address:        
    Phone number:      

 

Accommodation of Teaching and Advising Duties

  Teaching
    Course:        
    Date and time:        
    Instructor in charge:        
    Alternative arrangements (eg rescheduling the class):
      

Advising
    Undergraduate:        
    Graduate:        
   

No URLs will be accepted in this form, due to spam-prevention issues.

     

 

 
Prof Luke LeeProf. Luke Lee
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