Leave Request Form

Resident's Full Name (First name, Last Name) *

Resident's Email Address *

Leave Request Specifics

I would like to request the following time off

From: *

Month

Day

Year

To: *

Month

Day

Year

Site *

Other (Specify)

Period *

Rotation during which leave is requested *

Reason(s) *

Additional Reason(s) (please specify)

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Department and University Information

Division of General Surgery & General Surgery Residency

Division office: 1650 Cedar Avenue, L9.309
Montreal, Quebec, Canada, H3G 1A4
domenica.cunzo@muhc.mcgill.ca Residency Office: 1650 Cedar Avenue, L9.424
Montreal, Quebec, Canada, H3G 1A4
rita.piccioni@mcgill.ca

Annual vacation
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Writing exam
Fellowship interview
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Leave Request Form

Department and University Information

Division of General Surgery & General Surgery Residency