USC Radiology
| Request for Time-Off
Radiology Forms
In order to process your Request for Time-Off, you will need to complete the following form. If the RTO is not complete, Juanita Evans will return the form. Once filled out appropriately, Juanita will submit RTO to Division Head for approval. Division Head will notify Juanita. Juanita will forward response electronically to faculty/fellow. Any questions as to the status, please contact Juanita at (323) 442-8541.
Name & Email
Meeting
Dates Requested
Submit
Name:
Lastname:
Email Address:
Support Staff email:
Designation
Faculty
Fellow
Division:
Body Imaging
MusculoSkeletal Imaging
Neuroradiology
Nuclear Medicine
Vascular & Interventional Radiology
Women's Imaging
Research
RTO Type:
Vacation
Academic Leave (Paper)
CME
Departmental Leave
Grant Funded
Jury Duty
Sick (Self)
Sick (Family)
Disability Leave
Cancel Leave Request
Benefit to Department: