The purpose of this form is to notify the GME office when a GME trainee is out for an extended leave. Extended leave is defined by a). Use of the GME Additional 2 Weeks leave or b). Use of 3 or more consecutive sick days. Please fill out the form as soon as intention for extended leave is known; it can also be filled out retroactively in the case of emergent leave.
This form is for notification purposes only; it allows the GME office to coordinate with the program, the trainee, and the employer to ensure clear communication surrounding any extended leave taken by a GME trainee.
This form should be completed and submitted by program leadership.