TIME OFF REQUEST FORM

If you are requesting time off, please complete and submit this form at least 14 days in advance.

Music Teachers: instead of canceling lessons, please attempt to arrange a substitute with our existing staff first.

Name

First Name

Last Name

Email Address

Number of Days Requested

Start Date Requested

YYYY

End Date Requested

YYYY

Type of Request

Check one of the following:

Vacation

Personal Leave

Funeral/Bereavement Leave

Jury Duty

Family/Medical Leave

Time Off to Vote

Will Be Late for Shift

Other

Substitute

If you have previously arranged a substitute, please indicate who will be covering your shift(s).

Comments/Notes

Employee Acknowledgement

I understand that time off is subject to approval.