Clinical Faculty Time Off Requests Submission Date* Date Format: MM slash DD slash YYYY Name* First Last Role*Faculty (MD)Faculty (PhD)Faculty (NP)StaffType of Time Off Request*VacationSickCMEInvited Speaking EngagementBereavementJury DutyFMLAMilitary LeaveOther (please explain in notes section below)Name of Coverage (MD's only)*Rita Blanchard, MDPeter Everett, MDKevan Hartshorn, MDGretchen Gignac, MDNaomi Ko, MDMatthew Kulke, MDAdam Lerner, MDLillian McMahon, MDRebecca Miksad, MDAndreea Negroiu, MDLauren Oshry, MDKaren Quillen, MDVaishali Sanchorawala, MDShayna Sarosiek, MDMark Sloan, MDNot Applicable*NP's do not require coverage. Please select the last option on the drop down list above (not applicable)*Start Date* Date Format: MM slash DD slash YYYY End Date* Date Format: MM slash DD slash YYYY Notes