Information about the Information Form for Leave of Absence

Note: The Leave of Absence form is available to unit administrators within the EBS portal.

The Information for Leave of Absence (Faculty/Academic Staff) form is submitted as an attachment to the Leave of Absence form for all leaves except sabbatical, medical, maternity or U.S. Military leaves.

Name: As recorded on the Social Security card, except type last name first with a comma after and then the rest of the name.

Special supplemental income arrangements during leave: A response must be given;  write "none" if there are no special supplemental income arrangements.

Check either Paid leave or Unpaid leave and provide the requested information.

Faculty/Academic Staff signature: Signature of the individual who is going on leave.

Statement of chairperson:  The electronic approval of the Chairperson and Dean on the Leave of Absence form is considered to be the sign-off on this statement.

Routing: Follows the electronic routing of the Leave of Absence form to which it is attached.