Remote Work Documentation Form

Your Name Your Name * First Last
VP Area *

VP Area President's Office VPAA VPBA VPSA VPUA VPEM
Supervisor Email *
Dates of Remote Work

Not to exceed 4 days consecutively or 4 days a month per IGP 191.
First Day of Remote Work First Day of Remote Work * / MM / DD YYYY
Last Day of Remote Work Last Day of Remote Work * / MM / DD YYYY
Detail the University project-based priorities, critical deadlines, and/or extra-ordinary (non-continuing) situations that warrant short-term remote activities: *
Acknowledgement *

Acknowledgement I understand that I should have communicated with my supervisor about my need for remote work before submitting this form.