Leave Request Form

Today's Date
GatorLink Username*
Name*
First Last
Beginning Date*
Beginning Time*

: HH

MM
End Date*
End Time*

: HH

MM
Type of Leave*
- Vacation
- Sick
- FMLA
- Other
More than one type of leave may be entered on the application if used during the same period of absence. (e.g. 6 hours of vacation and 2 hours sick leave)
If you chose "Other," please provide more information.*
Total Hours Absent*
(Round to quarter-hour increments: .25, .50, .75, as appropriate. If using multiple types of leave, please indicate how you would like your time allocated.)

Department of Physical Therapy