Substitution Request Form

Name of Absent Faculty:

Date of Substitution:

Name of Substitute Faculty or Teaching Assistant:

If Teaching Assistant, provide rate:

Campus:

Program:

Course Name:

Total Number Hours:

Select One (Absent Faculty Only):

Unpaid (Not using Sick, Bereavement or Jury Duty)

Absent Faculty Requested Paid Leave (Sick, Bereavement or Jury Duty) via TriNet

TriNet Hours Requested:

Comments:

Absent Faculty

Signature:

Date:

Academic Dean Signature

Signature:

Date:

Special Notes:

Unless otherwise required by applicable law, Paid Sick Leave may only be used for: Illness, injury, or health condition, Preventative care, Medical diagnosis, Care or treatment of physical or mental illness, or Care for a family member who is ill or has injuries.

Unless otherwise required by applicable law, full-time and part-time employees, including adjunct faculty, may take up to five (5) workdays for the death of an immediate family member or domestic partner.

Unless otherwise required by applicable law, full-time employees summoned for Jury Duty will be paid their full salary for up to five (5) days when written proof of Jury Duty is provided. Part-time employees, including adjunct faculty, will be paid their hourly rate of pay for regularly scheduled hours works on the day(s) of the jury duty for up to three (3) days when written proof of Jury Duty is provided.

Faculty Substitution Request Form

Absent Faculty

Academic Dean Signature

Special Notes: