Click HERE to download a fillable form (for Explorer or Firefox only does not work in Safari)
Once you have filled out the form you can click on FILE and email it to your supervisor.
You can also click on FILE -> PRINT to print the form either completed or blank.
Occupational Therapy Division - University of Michigan Health System
Request for PTO
Date submitted: Request time off desired. State first choice and second choice. Clearly designate between the two requests. Attempts will be made to provide you with your first choice(s). If that is not possible, attempts will be made to grant second choice(s). Coordinate requests with other team/department members before submitting form.