Time Off & Sick Leave

This form is used when submitting time off requests or sick leave. Requests should be submitted at least two (2) weeks prior to requested date(s). When accident or illness prevents submitting a request beforehand, submit this form immediately upon return to work.

Teacher Name

First Name

Last Name

Email Address

Mark type of leave (Check all that apply):

Vacation Leave

Sick Leave (Illness, Doctor Appointment, Injury, Bereavement, etc.)

Jury Duty (Provide a copy of notice to the Administrative Staff)

Military Leave (Provide copy of military order to the Administrative Staff)

Date Requested (From)

YYYY

Date Requested (To - if applicable)

YYYY

Please grant this leave request as a result of the following circumstance(s) (Provide appropriate and adequate details):