Time off request
Please submit the times you need to take off work and the type of leave you are taking.
Type of leave
Description if needed. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum.
Sick leave (Illness or Injury)
Bereavement leave (Immediate Family)
Bereavement leave (Other)
Jury duty or legal leave
Reason for leave
Total Number of Sessions Missed
Please indicate instructions for sessions missed
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