Department of Neurology Resident Leave Request Form
Contact Information
For questions, please contact Neurology.Residency@cuanschutz.edu
Please fill out the resident leave request form below.
Full Name: *
Email: *
Type of Leave: *
Vacation Conference Change Request
Dates of absence (include weekends)
Leave Begin Date (MM/DD/YYYY): *
Leave End Date (MM/DD/YYYY): *
Rotation: (At the time of requested leave) *
Location: * UCHVADHCHCOOther/Comments
Do you have any clinics scheduled during this time? *
Yes No
Conference: *
Location: *
If using educational funds, please complete a Department of Neurology Travel Authorization Form http://neurology.ucdenver.pvt/authorization.php
Dates originally requested:
Begin Date (MM/DD/YYYY): *
End Date (MM/DD/YYYY): *
Comments:
