Resident/Fellow Leave Request Form

Please fill out the following Leave Request form.

If travel expenses are being requested, please complete the Neurology Request for Travel Approval form and mail to your Department Accountants: Gwen Young Perihan Brown PO Box 100236 In an effort to strengthen the ability of the university to ensure the safety of faculty, staff, and students participating in official university international travel, a new and much simplified registration procedure will be implemented. This registration procedure does not apply to students traveling on UF-sponsored, exchange or non-UF study abroad programs, nor to those undergraduates doing independent study abroad. All other members of the UF community who are traveling on officially-sanctioned UF business outside the United States are required to register their travel on the UF International Center website. If you have any problems using this page, please contact Webmaster.

Name*
First Last
Resident/Fellow Email Address:*
Type of Leave*
Begin Date*
MM slash DD slash YYYY
Begin Time*

: Hours

Minutes

AM/PM
End Date*
MM slash DD slash YYYY
End Time

: Hours

Minutes

AM/PM
Total Days Absent from Work*

Please enter a value between 0 and 99
Clinic Scheduled Day?*
- Yes
- No
- Not a Regular Clinic Day
Are you on Ward Service? (Shands In Patient, Shands Stroke, VA, Night Float)
If "Yes" who will cover you?
Please be specific and indicate each date with specific person covering your spot.
Purpose of Schedule Change?
Are Travel and Expenses Required?*
- Yes
- No
If this is a Professional Leave and you are requesting expenses you MUST request these separately. Please complete this form and then fill out the Travel Authorization form found under the "Resources for Administration, Faculty and Staff" section of this website or use the link below. BE SURE TO SUBMIT THIS FORM by using the SUBMIT button below!
Click here to fill out the Travel Expense Form