UTSC Catastrophic Leave Application Form
This form is to request a withdrawal of days from the Catastrophic Leave Bank.
UTSC Logo unitedteacherssc.org web address and 408-379-0553 phone number
Date *
MM
/
DD
/
YYYY
Name *
School Site *
Personal email address *
Home Address *
City *
Home/Cell Phone *
School Phone *
Number of Days Requested *
Nature of Illness or Injury *
Verification Provided (Please attach)
Submit
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