Faculty Leave
&
Clinic Schedule Change Request

Your Name:
Your email address:
Type of Leave:
Beginning Date: e.g. mm/dd/yyyy Time: e.g. 7:30 am
Ending Date: Time:
Total Hours:  
Clinic Schedule changed?  
Assistant Medical Director onsite approved? Yes  No 
ACU Manager notified? Yes  No 
Clinic Covered by (type name)?
Are travel expenses requested? Yes  No 
Purpose of schedule change?
 

A copy of the UF Leave Application must be completed.

Please complete, and mail to

Maria Bolanos
PO Box 100237
(352) 273-5151

If travel expenses are being requested,
please complete the CHFM Request For Travel Approval form and mail to

Travel Request 
PO Box 100237
 (352) 273-5141