COLLEGE  OF   FINE  ARTS  AND  COMMUNICATION
		  Twelve Month Administrative Leave Request

                                            	                                                              	                                        
Department  _______________  Name  ____________________	Date  ___________

Date(s) Requested:	_________________________________________________

Type of Leave Requested: 	

_____Vacation	_____Other 	Please specify: __________________________
				

				
				___________________________________
				Employee's Signature

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				Approved by Department Chairperson/Manager

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				Approved by Dean
				(Dean's signature is approval of time requested)
(Revised 7/00)

NOTE: A COPY OF THIS REQUEST WILL BE KEPT IN THE DEAN'S OFFICE TO KEEP LEAVE  RECORDS UPDATED.