JHMI PARKING SERVICES
	LEAVE OF ABSENCE / ROTATION FORM
	This form will reserve your parking assignment for a no less than one (1) month and up to a  maximum of six (6) months. NOTE: Monthly-pay parkers must report to Harvey 108 upon their  return to re-activate your parking.

(Print this form, complete and fax to 410-502-3907 or submit in person at the Parking Office located in Harvey 108).

Date: ____________________

Name: ______________________________________________________________

Social Security Number: ______- ______- _______

ID Badge Number: ___________________

Employer: ________________________________________________________________

E-mail Address: ______________________

Work Phone: ___________________

Current Parking Assignment: ____________________________________________________

PLEASE RESERVE MY PARKING ASSIGNMENT:

From (Beginning Date): ____________________ To (Ending Date): ____________________

Approximate Length of Absence (no less than one (1) month and no longer than six (6) months): ____________________

Reason for Request:

Upon your return to work, you must complete a "Return From Leave of Absence Form" and submit to
the Parking/ID Office at Harvey 108. The "Return From Leave of Absence Form" cannot be submitted until you return.