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-Work related eventName of Coverage (MD's only)*Maya Abdallah, MDJose Acevedo, MDNana Addo-Tabiri, MDHussein Assi, MDBritney Bell, MDCamille Edwards, MDPeter Everett, MDGretchen Gignac, MDMeredith Halpin, MDKevan Hartshorn, MDNaomi Ko, MDMatthew Kulke, MDAdam Lerner, MDKatie Li, MDEric Marks, MDLillian McMahon, MDRebecca Miksad, MDAfia Mirza, MDAndreea Negroiu, MDLauren Oshry, MDGeoffrey Oxnard, MDFabio Petrocca, MDJean Antoine Ribeil, MDVaishali Sanchorawala, MDMark Sloan, MDAndrew Staron, MDRaphael Szalat, MDUmit 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