Leave Request

For discretionary leave, this form must be submitted for approval prior to the time you are requesting to be absent from.

Upon request, absences for personal or family illness must have a written statement from a health care practitioner attached.

Employees requesting extended leave of more than five days must schedule a conference with the personnel office to discuss available leave.

Leave requests will be granted in accordance with board policy DEC.

Name Name First Last
Email
Position/Job Title
Department/Campus
Your Administrator? (Who do you need to send this form to?)
Type of Leave

Type of Leave School Sponsored Event Workshop Personal Medical Appointment Illness or Medical Appointment in Family Death in Family Leave to Care For Newborn or Placement of Child Jury Duty or Subpoena Personal Business or Other Discretionary Reason
Specify Event
Specify Relationship
Total Number of Days

Total Number of Days 1 Full Day 1 Half Day AM 1 Half Day PM Other Other
Date You Will Be Out Date You Will Be Out / MM / DD YYYY
First Day That You Will Be Out First Day That You Will Be Out / MM / DD YYYY
Last Day That You Will Be Out Last Day That You Will Be Out / MM / DD YYYY