Work Schedule Change – Request Form Work Schedule Change Step 1 of 3 33% Preparer Information Preparer Name(Required) Your name First Last Preparer UW Email(Required) Your UW email address Alternate Contact In the event of your absence, who should be contacted? First Last Alternate Contact UW Email Alternate contact's UW email address EO Assistance(Required) Did you consult with or receive assistance from an Executive Office Shared Environment team member prior to filling out this form? No Yes Team Member Name First Last Employee Information Employee Name(Required) First Last Employee UW Email(Required) Employee Unit(Required) -CHOOSE ONE-Academic Personnel & Faculty (APF)Academic Strategy & Affairs (ASA)Attorney General Office (AGO)Division Campus Community Safety (DCCS)Enrollment Management (EM)Executive Office (EO)Shared Governance (SG) APF Sub-Unit(Required) -CHOOSE ONE-APF: Faculty AffairsAPF: Faculty DevelopmentAPF: Faculty Inclusive ExcellenceAPF: Vice Provost Leadership & Management ASA Sub-Units(Required) -CHOOSE ONE-ASA: Academic Technologies, Learning Technologies, Student Technologies & ServicesASA: Center for Teaching & Learning (CTL)ASA: Information Services (ASA-IS)ASA: Vice Provost Leadership & Management DCCS Sub-Unit(Required) -CHOOSE ONE-DCCS: Emergency ManagementDCCS: Husky Assist Mobile Response TeamDCCS: SafeCampusDCCS: UW Police DepartmentDCCS: Vice President Leadership & Management EM Sub-Unit(Required) -CHOOSE ONE-PRES: Board of Regents (BOR)PRES: CorePRES: Environmental Health & Safety (EH&S)PRES: Internal Audit (IA)PRES: OmbudPRES: Population HealthPRES: University Rules & PolicyPRES: UWINCO EO Sub-Unit(Required) -CHOOSE ONE-EO: Board of RegentsEO: Environmental Health & SafetyEO: Executive Office of the President & ProvostEO: Health Sciences ServicesEO: Internal AuditEO: OmbudEO: Strategic InitiativeEO: University Rules & PolicyEO: UWINCO Work Schedule Changes Effective Date(Required) New work schedule effective date MM slash DD slash YYYY Employee Change Request(Required) Who is initiating this request? Employee Management FTE Change(Required) Does this work schedule change include an FTE change? Yes No New FTE Percentage New Work Schedule(Required) Ex: M-F 8-2 PST Correspondence Documentation Upload(Required) Upload correspondence of schedule change request (employee initiated and manager approval). Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 15 MB. Notification Documentation Upload(Required) Upload formal notification of schedule change. Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 15 MB. Additional Information Provide any additional, relevant information on needed action.