Moonlighting Request

NOTE: Housestaff are required to notify the program director of all moonlighting hours.

Name:  PGY:  Rotation:

Approval to moonlight is requested for the following:

Month/Year:  Hours Per Month:


  • Any hours a resident works for compensation at the sponsoring institution or any of the sponsor's primary clinical sites must be considered part of the 80-hour weekly limit on duty hours.
  • Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.


I have read the program policies on moonlighting and duty hours and affirm that the above request will not violate these policies.