Part-Time Faculty Leave of Absence Notice Form:

First Name:

Last Name:

E-Mail: (Required)

Starting Date for Leave:

-- 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Please indicate if you would like to be taken off faculty distribution lists during your leave of absence:

Yes
No

Expected Date of Return (if known):

-- 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Note:  If expected date of return is not known at this time, please contact Krystyna Karwalajtys (contact information below) when return date is confirmed.

Krystyna Karwalajtys
Faculty Appointments, Tenure & Promotion Assistant
Department of Family Medicine, Faculty of Health Sciences
McMaster University, McMaster Innovation Park
175 Longwood Road South, Suite 201A
Hamilton, ON  L8P 0A1
Tel: 905-525.9140 x21742  Fax: 905-521-5594
Email: Krystyna Karwalajtys