Variance Form

Instructions: The Variance Form is to be submitted by faculty two weeks in advance of any absence from a required function. The form is required for any absence exceeding five minutes. The Variance must be pre-approved by the Dean. A separate form must be used for every Variance.

1. I will be absent from: (check only one)

          my office hours (specify:                                 )

          class (specify:                                 )

          a committee meeting (specify:                                 )

          a mandatory workshop (specify:                                 )



2. Anticipated date and time of absence:


Time: from              (A.M./P.M.) to              (A.M./P.M.)

3. Reason for absence: (check all that apply)



          death in family

          death of self

          bathroom needs

          travel to conference

          scheduling conflict

          medical appointment

          appointment with Administrator

Explanation: Briefly summarize the activities or events that necessitate the absence. Provide doctors' excuse, funeral notice, conference agenda etc. as applicable.

Faculty signature                                                                        Date

Department Chair's signature                                                       Date


Dean's signature                                                                        Date

Return to Dean Heptune's desk.