Clinical Faculty Time Off Requests Submission Date* MM slash DD slash YYYY Name* First Last Email Address* Role*Faculty (MD)Faculty (PhD)Faculty (NP)Faculty (Genetic Counselor)Type of Time Off Request*VacationSickCMEJury DutyOther-Work related eventName of Coverage (MD's only)*Maya Abdallah, MDJose Acevedo, MDHussein Assi, MDBritney Bell, MDYenong Cao, MDPeter Everett, MDGretchen Gignac, MDMeredith Halpin, MDKevan Hartshorn, MDAdam Lerner, MDLillian McMahon, MDRebecca Miksad, MDAfia Mirza, MDAndreea Negroiu, MDLauren Oshry, MDGeoffrey Oxnard, MDFabio Petrocca, MDVaishali Sanchorawala, MDMark Sloan, MDMaya Srinivasan, MDAndrew Staron, MDRaphael Szalat, MD, PhDUmit Tapan, MDAndrew Wilks, MDLesley Wu, MDN/A*NP's do not require coverage. Please select the last option on the drop down list above (not applicable)*Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Notes