Travel Form
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Tulane University School of Medicine Faculty and Staff Leave Request and/or Travel Authorization 1.
Name of Employee requesting leave and/or travel authorization:
2.
Dates of Leave and/or Travel: Start
3.
Employee's Department:
4.
Leave Type:
Professional
Date of Request:
End
Return
Department Box #:
Campus Phone #:
Education
Vacation
Speak/Present, etc.
Con't. Ed.
Floating Holiday Staff Only
FMLA Family Medical Leave Act
Sick Leave
Other
5.
If University Business: Purpose of Travel:
Source of Funds:
Estimated Cost $
Travel Type:
Domestic
City of Origin, e.g., New Orleans, Biloxi
6.
Person(s) responsible for service during my absence:
International (REQUIRES DEAN'S PRIOR APPROVAL) Destination
SOM/Dept. MCLNO TUHC VAMC Other
7.
Emergency Telephone number where I may be reached:
9.
Signatures as required by University rules. University travel must be approved by employee's supervisor. International travel must be approved by the Dean in advance of travel.
(
)
Signature Dates Requester: Section Chief (if required): Department Chairperson: Director (if required): Dean: Sr. VP - HSC (if required): Rev. SOMED Dean's Office 7/1/00
Name of Employee requesting leave and/or travel authorization:
2.
Dates of Leave and/or Travel: Start
3.
Employee's Department:
4.
Leave Type:
Professional
Date of Request:
End
Return
Department Box #:
Campus Phone #:
Education
Vacation
Speak/Present, etc.
Con't. Ed.
Floating Holiday Staff Only
FMLA Family Medical Leave Act
Sick Leave
Other
5.
If University Business: Purpose of Travel:
Source of Funds:
Estimated Cost $
Travel Type:
Domestic
City of Origin, e.g., New Orleans, Biloxi
6.
Person(s) responsible for service during my absence:
International (REQUIRES DEAN'S PRIOR APPROVAL) Destination
SOM/Dept. MCLNO TUHC VAMC Other
7.
Emergency Telephone number where I may be reached:
9.
Signatures as required by University rules. University travel must be approved by employee's supervisor. International travel must be approved by the Dean in advance of travel.
(
)
Signature Dates Requester: Section Chief (if required): Department Chairperson: Director (if required): Dean: Sr. VP - HSC (if required): Rev. SOMED Dean's Office 7/1/00
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