CTHS Request for Leave
Please submit the times you need to take off work and the type of leave you are taking.
Email address
Campus
Name
Your answer
Days Requested
Your answer
All Day
Type of Leave
Description if needed.
Reason for Leave
Your answer
Are you traveling and seeking reimbursement?
Miles at $.31 per mile and total
Your answer
Registration Fee:
Your answer
Air, rail, or taxi travel cost (list name and cost ex: Taxi $50, Air $500)
Your answer
Hotel Cost
Your answer
Meals and incidentals costs
Your answer
Tolls, Parking, Baggage Fees. (List fees with description)
Your answer
Total reimbursement cost seeking:
Your answer
Time Remaining (Please do not fill this section out)
A copy of your responses will be emailed to the address you provided.
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