APPLICATION FOR APPROVAL OF ABSENCE ON DUTY Academic Staff	FORM 17.04a
Staff Member to complete					           	Macquarie  University 9 February 2002

Division/ Office: ______________________________________	Budget Unit: ________________________________

Family Name:  _______________________________   Other Names: ______________________________________  

Employee Number:  _______________________	Extension Number:  _______________

Period of Absence 	From:	             /          /          	To:	             /          /          

NOTE: All other associated leave, such as Annual Leave, Long Service Leave or Leave Without Pay must have been approved separately by the appropriate delegate.

Tick one or both reasons for which approval is required

q	Outside Australia  		Destination:	
q	Exceeds 5 weekdays during teaching / examination period
Reason for Absence (Please tick appropriate box(es))
q	Research			q	Teaching Macquarie Course
q	Other purposes (specify):	  
q	Attending Conference, another institution - as follows: 

Additional Comments (if desired)	

Signature of Staff Member:  ____________________________			____/____/____
											 (Date)

Recommended: _______________________________				____/____/____
			Supervisor						 	(Date)

Approved	_______________________________________________	____/____/____
			Head of Division/Office						 (Date)

Recorded and Filed in Division/Office: _________ (inits)  			____/____/____
								              		(Date)
					Division/Office Reference No.:     ___________________