Dept. of Human Services Absence Notification Form - Unit A & B

Name: Name: * First Last
Email: *
Employment Status: *

Employment Status: Unit A Faculty Unit B Faculty
Date of Absence Date of Absence * / MM / DD YYYY
Type of Used Leave: *

Type of Used Leave: Accrued Leave Sick Leave Family Sick Leave Personal Leave Bereavement Leave Court Required Leave Leave without Salary Travel Other Other
Total Hours:
Leave Reported in Quarter-Hour Increments *
Date of Absence Date of Absence / MM / DD YYYY
Type of Used Leave:

Type of Used Leave: Accrued Leave Sick Leave Family Sick Leave Personal Leave Bereavement Leave Court Required Leave Leave without Salary Travel Other Other
Total Hours:
Leave Reported in Quarter-Hour Increments
Date of Absence Date of Absence / MM / DD YYYY
Type of Used Leave:

Type of Used Leave: Accrued Leave Sick Leave Family Sick Leave Personal Leave Bereavement Leave Court Required Leave Leave without Salary Travel Other Other
Total Hours:
Leave Reported in Quarter-Hour Increments
Date of Absence Date of Absence / MM / DD YYYY
Type of Used Leave:

Type of Used Leave: Accrued Leave Sick Leave Family Sick Leave Personal Leave Bereavement Leave Court Required Leave Leave without Salary Travel Other Other
Total Hours:
Leave Reported in Quarter-Hour Increments
Date of Absence Date of Absence / MM / DD YYYY
Type of Used Leave:

Type of Used Leave: Accrued Leave Sick Leave Family Sick Leave Personal Leave Bereavement Leave Court Required Leave Leave without Salary Travel Other Other
Total Hours:
Leave Reported in Quarter-Hour Increments
List these dates/times here if a full day (7.5 hours) was not taken for any of these (e.g., 3/1/24 gone from 2-4:30pm and missed office hours).
How are you covering your responsibilities while absent?
Example: GA Coverage, Online Assignment
If you need a message posted on your office or classroom door, provide the room number and message text.