Leave Request

Please review the calendar prior to submitting a Leave Request Form

This form is to be completed in full whenever you are requesting leave of any kind. please submit requests two weeks in advance of your requested leave time.

Name*
First Last
Email
I request leave for the following reason:*
- Vacation Leave
- Sick Leave
- Leave Without Pay
- Jury Duty
- Bereavement
Please provide specific information*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Return to Work Date*
MM slash DD slash YYYY