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Vacation/Leave Request

In order to be considered, vacation/leave requests MUST be submitted on this form. Email or verbal requests will not be considered. Requests are approved on a first-come first-served basis, with educational leave taking highest priority.

  • Use one form for each schedule block
  • If your requested dates fall between two blocks, you must complete and submit two separate forms.
  • According to PAIRO Guidelines, all residents are entitled to 4 weeks’ vacation per year, which can be taken consecutively or in 1 week blocks. If you are only doing a 1 month rotation with Emergency Medicine we would encourage a maximum vacation time of 1 week during the rotation as more time off will take away from the educational value of the rotation for you and make evaluation difficult.
Contact Information
Reason for Absence
  • Use one form for each schedule block
  • If your requested dates fall between two blocks, you must complete and submit two separate forms.
Type of leave
Date(s) requested
Date(s) requested
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