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:                                 )

          commencement

          convocation
 

2. Anticipated date and time of absence:

Date:

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

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

          illness

          accident

          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
 

Approved/Disapproved

                                                                                                
Dean's signature                                                                        Date
 

Return to Dean Heptune's desk.