Request for Leave Form
Please submit this form with 10 days advance notice
Your Name *
Today's date *
MM
/
DD
/
YYYY
Type of Leave Requested *
If you selected "Bereavement Leave" above, please indicate relationship to the deceased.
Type of Staff *
FOR FULL DAY ABSENCES - Answer the next 3 questions. FOR PARTIAL DAY ABSENCES- Skip the next 3 questions and answer the following 3.
FULL DAY - Start of Absence
MM
/
DD
/
YYYY
FULL DAY - End of Absence
MM
/
DD
/
YYYY
FULL DAY - Number of days requested
PARTIAL DAY - Date of Absence
MM
/
DD
/
YYYY
PARTIAL DAY - Beginning to end time
PARTIAL DAY - Number of hours requested
If needed, has a guest teacher been requested
Clear selection
Name of Guest Teacher
What is your morning duty and who will cover it?
What is your afternoon duty and who will cover it?
TAs and EAs ONLY, please indicate who you work with and if you will need coverage for any Special Needs Students
Additional Comments
Submit
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