Academic Advisor Research Leave of Absence Form
Submit your request for a research leave of absence. Please provide all required details and supporting documents.
Advisor Full Name
*
First Name
Last Name
Advisor Email Address
*
example@example.com
Advisor Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Academic Department
*
Please Select
Biology
Chemistry
Physics
Mathematics
Computer Science
Engineering
Humanities
Social Sciences
Other
Faculty Position/Title
*
Please Select
Assistant Professor
Associate Professor
Professor
Lecturer
Other
Date of Initial Employment at Institution
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Leave Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Leave End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purpose and Description of Research Leave
*
Location(s) Where Research Will Be Conducted
*
Have you taken a research leave in the past 5 years?
*
Yes
No
If yes, please provide details (year, duration, purpose)
Upload Supporting Documents (e.g., research proposal, invitation letter)
*
Upload a File
Drag and drop files here
Choose a file
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of
Department Chair Name
*
First Name
Last Name
Department Chair Email Address
*
example@example.com
Advisor Signature (Please sign to confirm the accuracy of the information provided)
*
Submit Request
Submit Request
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