Memorandum of Absence

Memorandum of Absence
Name

First NameLast Name
Email
example@example.com
Faculty or staff
Travel Start Date:

MonthDayYear
Travel End Date:

MonthDayYear
Reason for absence:
Primary Purpose of Travel
Meeting/Event Name:
Location of Travel:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please outline how your duties will be handled in your absence.
Funding source:
Total amount requested:
Who is providing the funding:
Cost Center/Fund Name:
Documentation of participation

Cancelof
During this travel, will you participate in a workshop, panel, session or other activity that will enhance your online teaching?
Provide documentation of the online teaching activity you will participate in

Cancelof
Please include any additional information or notes which may help facilitate this request.
Should be Empty: