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Volunteer Services - Request a Leave of Absence

Any active, on-site hospital volunteer with a record in good standing (72 hours or more) who wishes to take a leave from volunteering lasting six weeks to a maximum of nine months from their last recorded hours should submit this Leave of Absence form. They must also notify their Staff Volunteer Supervisor, College Student Leader Board member, and/or Community Volunteer Lead. Volunteers on Leave of Absence keep their photo ID badges and continue to receive general communications from our department but will not have compliance requirements.

For example, the Leave of Absence form should be completed if you plan to take the summer off or have a temporary health concern. You should return your photo ID badge to the Volunteer Services office if you plan to take two semesters off or expect to be away from service longer than nine months.

If you have questions about the best plan for your particular situation, please contact the Volunteer Services office and a staff member will assist you.

The beginning date of your leave.
The date you can return to work.

I understand that by becoming a volunteer at UI Hospitals and Clinics, I committed to volunteering three hours per week for six consecutive months or two semesters. Considerable hospital resources have been dedicated to screen, collect background information, health screen, photo ID badge, appropriately orient, assess, train, place and supervise me, and my dependability directly affects the quality of my placement, especially if I have direct patient contact. By submitting this request, I acknowledge I am aware of my obligations and will fulfill my commitment upon the completion of my leave.

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  • About Us
    • Work at UI Health Care
    • Mission, Vision, and Core Values
    • Leadership
    • Designations and Distinctions
      • Basic Facts
        • History
        • Medical Achievements
    • North Liberty Campus
      • North Liberty Campus - By The Numbers
      • North Liberty Campus Photos
    • Quality and Safety
    • Academic Departments
    • Care Coordination Division/Social Services
      • Advance Directives
      • Care Coordination Division History
      • Care Coordination Division Patient Medication Assistance Program
      • Care Coordination Division Transportation Assistance and Resources
        • Bus and Shuttle Services
        • Wheelchair Services
      • Clinical Social Work Services
      • Food Assistance and Meal Delivery Programs
      • General Financial Assistance Resources
      • Health Care Benefits Assistance Program (HCBAP)
      • Honoring Your Wishes
    • Critical Access Hospital Network
    • Info For... Directory
      • Volunteer Services
        • Become a Volunteer
          • College Student Volunteers
            • College Student Leader Board
            • College Student Volunteer Placement Options
            • Mentor Program
          • Community/Staff Volunteers
          • Special Projects for Volunteers
        • Resources for Current Volunteers
          • Virtual Lunch & Learn Events
          • Volunteer Hours Submission
          • Volunteer Services - Request a Leave of Absence
        • Sponsored Businesses and Featured Programs
          • Furry Friends
        • Volunteer Services Gift Cards
        • Where Does the Volunteer Services Money Go?
      • Donors
        • Donating Through the UI Center for Advancement
        • Donations
          • Frequently Asked Questions: In-Kind Gift Donations
      • Emergency Responders
        • Disaster Preparedness Is For Everyone
        • Ground Safety Education
      • Faculty & Staff
        • Clinical Staff Office
          • Clinical Staff - Verification Requests
        • Tuition Reimbursement
        • Engineering Services
        • Material Services Department
          • Linen Services
          • Mail Services
          • Material Services - Processed Stores
          • Material Services - Shipping and Receiving
          • Uniform Shop
        • University Employee Health Clinic
          • Employee Flu Vaccinations
          • Frequently Asked Questions: University Employee Health Clinic
          • Pre-Employment Screening for Health Care Personnel
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            • Communicable Disease Exposures and Reproductive Hazard Screenings
            • Respirator Fit Testing
            • Evaluation Following Exposure to Human Blood/Body Fluids
            • Special Population Screenings
            • Blood Pressure Monitoring Services for Employees
            • Tuberculosis (TB) Screening
        • Health Professionals
          • Center for Procedural Skills and Simulation (CPSS)
            • Team-Based Simulation Design and Debriefing
          • Provider Resources
        • Web Privacy Policy
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