Remote Work Form

Position eligibility for remote work arrangements is determined by the Division Vice President.

Augsburg’s remote work (telecommuting) policy can be found on page 88 of the Employee Handbook.

After eligibility for remote work has been verified staff should discuss remote work arrangements with their supervisor and submit a formal remote work arrangement.

Submit a Remote Work Plan

Remote Work Form Questions

  • I have read the Augsburg Remote Work policy
    • Find remote work policy on page 88 of the Employee Handbook:
  • Have you discussed remote work arrangements with your supervisor?
  • First name
  • Last name
  • Department – Division
  • Job title
  • Days per week on campus
  • Job Classification
  • Position Type
  • Augsburg employee ID #
  • Phone number where you can be reached during remote work hours
  • Location where you will be working remotely
    • Address, City, State, Zip Code

Remote Work Plan

  • Is this an initial Remote Work agreement or a revision to an existing Remote Work agreement?
  • Why are you choosing to work from home? What is the benefit of this remote work plan to the department? What is the benefit of the remote work plan to you?
  • Describe how, when and where you will accomplish the various components of your job under the new arrangement.
  • How flexible can your arrangement be? Can you alter your schedule temporarily if operational needs arise?
  • How will you and your supervisor constructively monitor and address any issues about your remote work agreement?
  • What is the duration for this remote work arrangement?
    • Ongoing remote work arrangements must be reviewed each semester.
  • Supervisor’s email address
    • A copy of this request will be shared with your supervisor for approval.
  • Remote Work Schedule
  • Outline your availability during a typical week
  • Please outline your daily schedule.
    • Monday work hours
      • If none leave blank
    • Tuesday work hours
      • If none leave blank
    • Wednesday work hours
      • If none leave blank
    • Thursday work hours
      • If none leave blank
    • Friday work hours
      • If none leave blank
    • Saturday work hours
      • If none leave blank
    • Sunday work hours
      • If none leave blank
    • Additional information


  • I will be reachable during designated working hours by phone, email and/or text
  • Augsburg University may visit my designated work location at mutually agreed-upon times to ensure that safe working conditions exist.
  • I understand that approval of this proposal does not constitute and will not be construed as a contract of employment. This remote work arrangement is not intended to supersede or override Augsburg University employment policies at any time. I also understand that if approved, my remote work can be altered, extended or eliminated based on business conditions.
  • Typing your full name below as acknowledgement of the above statements