CLASSROOM COVERAGE – REQUEST TO BE ABSENT
This form must be completed for any scheduled absence. Mark the proper box for:
Off-Campus Activity Requests
Leave of Absence Requests (Personal Necessity Leave, Jury Duty, etc.)
List all hours of instruction (day/evening) you will miss during this absence.
INSTRUCTOR’S NAME:
REASON FOR THE ABSENCE:
Name of Substitute
Class to be Paid
Lecture Hours Lab Hours Cancelled or
Course Section Date Time Yes No Alternate Assignment
Comments :
Revised: 2/6/01
01-0150-001W/jm