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Short Term Leave Request
Short Term Leave Request
Name
(Required)
First
Last
9 Digit Student ID Number
(Required)
Email
(Required)
Degree Program
(Required)
PhD-CPE
PhD-EE
MS-CNE
MS-CPE
MS-EE
MS-EPSE
Travel Start Date
(Required)
MM slash DD slash YYYY
Travel End Date
(Required)
MM slash DD slash YYYY
This field is hidden when viewing the form
Number of days – current request
(Required)
Justification – Optional
Have you taken a short term leave previoiusly?
(Required)
yes
no
Advisors Name
(Required)
Advisors Email
(Required)
