Education Request Form
Please submit education request form for approval
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Email *
Employee Number *
Last Name *
First Name *
Station Assignment
Shift Assignment
Course or event title *
Estimated costs (including tax)
Start date *
MM
/
DD
/
YYYY
End date *
MM
/
DD
/
YYYY
Type of leave *
Description if needed
Total Hours needed Coverage
Captain Approval *
Justification for attending 
A copy of your responses will be emailed to the address you provided.
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