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*VacationSickCMEOther-Travel, work related*CME requests are not counted as vacation days*Name of Coverage (MD's only)*Jose Acevedo, MDNana Addo-Tabiri, MDHussein Assi, MDCamille Edwards, MDPeter Everett, MDGretchen Gignac, MDMeredith Halpin, MDKevan Hartshorn, MDNaomi Ko, MDMatthew Kulke, MDAdam Lerner, MDEmily Mann, MDEric Marks, MDLillian McMahon, MDRebecca Miksad, MDAndreea Negroiu, MDLauren Oshry, MDGeoffrey Oxnard, MDFabio Petrocca, MDJean Antoine Ribeil, MDVaishali Sanchorawala, MDMark Sloan, MDAndrew Staron, MDRaphael Szalat, MDUmit Tapan, MDImad ud Deen, MDAndrew Wilks, 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