Request for Campus Absence – Power & Energy Systems

* NAME:

First

Last

* ABSENCE CATEGORY:

* UIN:

* NetID:

* PHONE NUMBER:

* DESCRIPTION OF ABSENCE/PURPOSE OF TRAVEL:

Please provide a detailed description of your upcoming travel, i.e., conference name, workshop, paper or poster presentation, meeting, etc. BE SPECIFIC!

CONFERENCE PAPER or POSTER TITLE/NUMBER:

If you are presenting a paper or poster, please provide the TITLE/NUMBER here.

* DESTINATION (City, State, Country):

* DATE FROM:

* DATE TO:

* EXPENSES WILL BE REIMBURSED BY THE UNIVERSITY:

YES

NO

* TOTAL ESTIMATED COST TO UNIVERSITY:

The costs include CONFERENCE REGISTRATION, TRANSPORTATION (airfare, bus, train, car rental, personal car mileage), LODGING, PER DIEM, etc.

* ACCOUNT NUMBER:

Provide the account number or name of the account that will fund your travel.

TCARD/PCARD PURCHASE:

Registration

Airfare

Lodging

Bus

Train

If you need registration, airfare, bus, train and lodging paid with a department card, please specify here.

IEEE MEMBER NUMBER:

Please provide your IEEE Member Number here, if you need registration paid for an IEEE conference. If it requires a secure login, please provide "User Name" and "Password" in the "NOTES" section at the bottom of this page.

AADVANTAGE NUMBER:

American Airlines Miles Program Number

CONFERENCE FOOD PREFERENCE:

Please provide this information if you require conference registration.

CLASS INFORMATION 1 - (For Instructors Only):

Course & Section / Day & Time/ Arrangements

CLASS INFORMATION 2 - (For Instructors Only):

Course & Section / Day & Time/ Arrangements

CLASS INFORMATION 3 - (For Instructors Only):

Course & Section / Day & Time/ Arrangements

NOTES: