Absence Change Request - Brescia University College

First Name*

Last Name*

Western Email*

Supervisor's Name*

Supervisor's Email*

Original Start Date*

Original End Date*

Original Number of Days (if applicable)

Original Number of Hours (if applicable)

Type of Absence*

Cancel Entire Period?

Yes

No

If you answered "no" to to not canceling the entire period, please fill out the next section.

New Start Date

New End Date

New Number of Days (if applicable)

New Number of Hours (if applicable)

Comments