Application for Resident

Application for Resident

Vacation / Conference / Course

Due TWO BLOCKS PRIOR to the beginning of the rotation.It is the resident’s responsibility to complete sections 1 to4 and forward the completed form via email to the Program Administrator.

Incomplete and late requests will notbe accepted.

a) Resident Name:
b) Home Program:
c) R Level:
d) Pager: e)EmailAddress:
a) Date of Vacation / Course (Include Title and Location) / Total # of Week Days Requested
(not including Sat, Sun & Stats)
3.
a)Block: b)Rotation and Site:
4.
Date Submitted:
Approval Section (to be completed by the preceptor)
5.Approval by Preceptor or Rotation Program Coordinator
Approved
Denied
Reason  / ure
6.Signature of Preceptor and Program Director
Preceptor or Designate:
Program Director:
DO NOT COMPLETE
Residency office use only: Entered in one45 Schedule / Yes / No
Emailed / Faxed to Home Program & Resident / Yes / No
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S / Vacation leave is not permitted during July 2 – 7 for incoming Residents. Vacation leave is pre-scheduled during block 7. Additional vacation leave during block 7 is not permitted without prior approval from Program Director. Only one resident may take Vacation / Educational Leave at a time during Respirology rotations. When more than one resident requests Vacation or Educational Leave for the same time, the first request will prevail. Approvals cannot be transferred between rotations. In the event of a rotation change, the Resident must submit a new application. Additional limitations may apply. Visit the Respirology Training Program website for details.
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E / Residents: Review the Policies and Limitations that apply to Vacation Leave (see website). Complete your section of this form and submit to the relevant Rotation Program Administrator. The Rotation Program Administrator must receive the form at least 56 days prior to the first day of the affected rotation. Residents can expect to receive the outcome of their application no later than 28 days after submitting it to the Rotation Director. Residents are responsible for timely submission and follow-up.
Rotations Director / Delegate: Please approve or decline the request within 14 days of receipt. If the request is declined, provide a reason and describe any options. Email your approved/denied request to the respirology program administrator.
Respirology Residency Program Office: Will provide a final approval or otherwise within 7 days of receipt and forward a confirmation copy to the Residents home Program Administrator mailbox.

Updated May 2014