Faculty Short Term Leave/Absence Request Form - 30 Calendar Days or Less


This form is to assist senate faculty in requesting weekday campus absences during the service period from the first day of the fall quarter to the last day of the spring quarter.   Reporting non-routine absences helps departments plan activities and also helps protect faculty and their families in the event of work-related accidents.

If you are traveling outside of California on UC business (i.e., related to your Professorial duties), you need to complete the business travel insurance form.  In addition, a number of countries, particularly in Europe, now require that your passport's
expiration date must be at least six months after you are scheduled to return from your destination.  Some countries require an expiration date in advance less than six months. We recommend that you check with the destination nation to learn its regulation before booking your flights in order to find out whether you need to renew your passport before you travel.  Additional guidance for international travel can be found at: https://global.ucsc.edu/funding-resources/travel.html

To facilitate compliance with both of these requirements, please complete a leave of absence request by completing and submitting the form below and by registering your travel at https://www.ucgo.org/uc-travel-insurance.

Leave Information
Name of conference/meeting/date/location or other purpose of leave.
Please describe your duties and specific arrangements for coverage in your absence.
Submitter Information
Person to Contact in Case of Emergency

Emergency info

Please list contact information for a person who we may contact in the event of an emergency related to you.