Funding Extension for HQP Leave of Absence Request Form

Name of Faculty Supervisor*

First Last

Name of HQP taking leave of absence*

First Last

Anticipated Leave Start Date

Anticipated Leave End Date

Duration of Extension Request

The extension term is expected to match the period of the leave indicated above
The extension term is expected to be different than the period of leave indicated above (please provide rationale in the comment section)

Comments

Provide any additional comments regarding the funding extension if required.

Confirmation

I would like to request an extension to QQSF funding to accommodate a leave of absence on my team.

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