HEALTH SCIENCES
REQUEST TO BE ABSENT
Name: ______________________________________________ Date Submitted:______________________________
Reason for absence: _________________________________________________________________________________
Location (City, State): _________________________________
Depart:
Macomb
___________ A.M. P.M.
Time
Departure
Date: ________________________________
Arrive: __________________
City
Return
Date:___________________________________
Depart: __________________
City
____________ A.M. P.M.
Time
Arrive:
____________ A.M. P.M.
Time
DAY OF WEEK
DATE
COURSE
Macomb
TIME
_____________ A.M. P.M.
Time
ARRANGEMENTS
(include GA’s
name)
Your participation___________________________________________________________________________________
(Specify presenting paper, attendance only, discussant, etc.)
Means of transportation:
Registration fee:
______State Car
______ Personal Car
______ Train
______ Airplane
Hotel/Motel accommodations:
_______ Single
_______ Sharing
_______ Number of nights
$____________
Other expenses:___________________________________________________________________________________
(Specify parking, taxi, airport shuttle, etc.)