Instructional Responsibility Waiver

Instructional Responsibility

First Name: Required

Last Name: Required

Your email (@uw.edu): 

  Job Title: Required

School/Division: Required

Quarter Requested: Required

Academic Year Requested: Required

Reason Requested: Required

How will teaching be distributed throughout the rest of the year?: Required

The Instructional Responsibilities Policy requires that you not be away from campus for a period greater than 2 weeks.: Required

By submitting this form, I agree that this adjustment to my teaching assignment will have no impact on students.

Chair or Dean's email address: Required 

Security Question: Required