Intern Schedule Change Request

This form is for all Graduate Counseling Interns. Leave may be used in 15 minute increments. This form may be used for more than one schedule change request, but only for the same month. Any requests for changes due to presentations, vacations, academic duties, university breaks, or GA requirements must be submitted and approved in advance. Requests for time off due to illness or unforeseen circumstances must be submitted as soon as possible after your return to the EIUCC for internship duties.

I am requesting a schedule change for (check all that apply) *

I am requesting a schedule change for (check all that apply) Professional Development (attending and/or presenting at a conference) GA requirement University break (I will be in the office) Finals week (I will be in the office) Illness / unforseen circumstances NCE / Comps / Thesis Defense Other - must specify Other - must specify
Proposed schedule change details *

examples:
8/12/24 5 hours due to illness; Make up 2 hours on 8/19/24 and 3 hours on 8/20/24

9/13/24: 7.5 hours for Play Therapy conference; make up 7.5 hours on 9/16/24

11/18/24-11/20/24 (Thanksgiving break):
in office
11/18/24 7.5 hours
11/19/24 5 hours
11/20/24 3 hours
Email *

A copy of this request will be sent to your email once submitted
Date Submitted Date Submitted * / MM / DD YYYY
Type your name to sign Type your name to sign * First Last