.\\" process using groff -ms -l
.\\" this document provided by Jean Richter, richter@eecs
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\f(PBUniversity of California
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College of Engineering
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Department of Electrical Engineering and Computer Sciences
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\s+2REQUEST FOR ACADEMIC LEAVE OF ABSENCE FOR SEVEN CALENDAR DAYS OR LESS\s0
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\s+1\f(PRThis form should be submitted to the Department Chairman (either
as an email attachment or on paper) at 
least one week in advance of the proposed leave.  For purposes of verification,
faculty members that you designate to be \f(PBin charge\f(PR of your classes/advising
during your absence \f(PBmust initial\f(PR this form prior to submission
for approval.
If you are submitting this request electronically, please attach
the email message from your substitute(s) confirming your arrangement.\s0
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\l'4.5i'\0\0\0\l'2.28i'
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\f(PB\h'1.75i'Name\0\0\h'3.25i'Date
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Absent from:\0\l'2.85i'\0\0to:\0\l'2.86i'
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Purpose of leave, name of conference, place, title of paper etc.: 
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Should this information be publicized in Engineering News?\h'.75i'\0\0\0\0Yes:\0_________\0\0No:\0_________
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Where you can be reached\h'.285i'Address:\0\l'4.42i'
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\0in an emergency:
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\h'.6i'\l'4.42i'
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Phone Number:\0\l'3.92i'
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Or, contact me by email:\0\l'3i'
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Local contact\h'1.2i'Name:\0\l'4.48i'
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\0in an emergency:
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Address:\0\l'4.33i'
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\0\0\0\0\0\0\0\0\0\l'4.33i'
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Phone Number and/or email:\0\l'3i'
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_____ Use my emergency contact information already supplied.
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Disposition of classes:\h'.6i'Course Number(s):\0\l'3.585i'
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Name(s) of faculty member(s) in charge:\0\l'2.33i'
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Signature of faculty member in charge:\0\l'2.46i'
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Alternative arrangement (e.g., rescheduling the class):
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Disposition of advising:\h'.46i'Graduate:\0_________\0\0\0Undergraduate:\0_________
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Name(s) of faculty member(s) in charge:\0\l'2.33i'
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Signature of faculty member in charge:\0\l'2.46i'
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\l'4.07i'\0\0\0\l'2i'
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\h'.85i'Signed, Department Chair\h'2.5i'Date
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\s-112/2001