Summer 2021 Request for Remote Work (Staff, Faculty, Administrators)

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Email *

First Name *

Last Name *

EMU ID# *

Best phone number for contact *

Please identify your request for Summer 2021 *

Fully remote: I would like to conduct all of my work from off-campus during the summer.

Partly remote: I would like to come to campus on limited days during the summer.

If partly remote, please specify your proposed on-campus work schedule for the summer

Please share how you will fulfill the essential functions of your position if the request is granted. In order to facilitate flex scheduling for multiple employees, this information will help supervisors to accommodate the variety of needs. (Your information will be held in confidence by HR. Some particulars may be shared with supervisors in order to make appropriate accommodations.) *

Please share the reasons for your request. In order to facilitate flex scheduling for multiple employees, this information will help supervisors to accommodate the variety of needs. (Your information will be held in confidence by HR. Some particulars may be shared with supervisors in order to make appropriate accommodations.)

Personal Health: I have an underlying condition, recognized by the CDC, that places me at a higher risk of severe illness from COVID-19.

Family Health: I live with a household member who has an underlying condition, recognized by the CDC, that places them at a higher risk of severe illness from COVID-19.

Dependent Care Responsibilities: I am a caregiver for school-age children who will be at home, or another family member who lives with me.

I have another reason for requesting to work entirely or partly off-campus.

If you have another reason for requesting to work entirely or partly off-campus, please specify below

Is there anything else you would like us to know about your work and family realities for the Summer? (Decisions regarding the Summer will be made as quickly as possible) Updates on our COVID-19 planning can be found here: emu.edu/coronavirus/ *

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