SOUTH RIVER PUBLIC SCHOOLS

VACATION CARRYOVER REQUEST FORM

                                                                        __________________

                                                                              (Today’s Date)

NAME _________________________________ ASSIGNMENT __________________

SCHOOL: _______________________________        

Reason for the vacation carryover: ___________________________________________                      

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Number of Vacation Days Taken This Year to Date:  __________

Number of Vacation Days Remaining to Date:        ___________

Number of Vacation Days Requesting to Carryover:  __________

(you are not able to carry over accumulated vacation days)

_____________________________________                                                  

Employee’s Signature                         (Date)        

_____________________________________    _________________________________

Director’s Signature                            (Date)               Principal’s Signature                   (Date)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

SUPERINTENDENT’S OFFICE ONLY

        Carryover Approved:   ____ Yes        ____ No

___________________________________________________

          Superintendent’s Signature                                    (Date)

EMAIL COMPLETED FORM TO DAWN ZUKOWSKI AND COPY ROBIN STEINHAUSEN.    DO NOT SEND INTEROFFICE.  YOU WILL BE NOTIFIED VIA EMAIL ONCE YOUR REQUEST HAS BEEN REVIEWED.

3/2024