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Absence Change Request
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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
*
Please Select
Personal Time
Sick
1/2 Staff Negotiated Day
Brevement
Vacation
Lieu Time
Leave of Absence
Jury Duty
Maternity/Parental Leave
Compassionate Care
Other (explain in comments)
Cancel Entire Period?
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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
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