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 (i.e. clinic block for student lecture, etc.) Please explain in notes section below.Name of Coverage (MD's only)*Nana Addo-Tabiri, MDNavid Alavi, MDHussein Assi, MDCamille Edwards, MDPeter Everett, MDGretchen Gignac, MDKevan Hartshorn, MDNaomi Ko, MDMatthew Kulke, MDAdam Lerner, MDEric Marks, MDLillian McMahon, MDRebecca Miksad, MDAndreea Negroiu, MDLauren Oshry, MDVaishali Sanchorawala, MDMark Sloan, MDClaire Smith, MDN/A (NP's only)*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