Affiliate of the New England College of Optometry

Please be sure to make an entry for each day (or period) of time-off.

To use this form, simply fill in the fields as required below. In the "date" section, if you are requesting a single day or session's absence, please fill in the "FROM" box and you may leave the "TO" box empty. If you are requesting multiple continuous days, i.e. a weeks wacation, please fill in the "FROM" and "TO" date boxes. When selecting a continuous range of dates, the "Sessions" selection will automatically be recorded as "ALL (sessions)."
To enter more than one day, click "Add this day" to add a set of blank boxes AFTER filling in  the current set of boxes.

Note: This form works best with Internet Explorer version 5.x or greater. Using other browsers may create unwanted or unexpected results.

This form will be automatically routed to the VP for Professional Services for review as soon as you click the "submit" button. You will also receive a copy of this form, provided you have entered a valid email address.