PTO Request Form
Name
*
First Name
Last Name
What type(s) of time off are you requesting?
Paid Time Off (PTO)
Comp Time
Conference Travel
Support Raising Travel
Other
PTO Dates Requesting
Total # PTO Days Requesting
If requesting a partial day, Total # PTO Hours Requesting
Comp Time Dates Requesting
Total # Comp Days Requesting
If requesting a partial day, Total # Comp Hours Requesting
Comp Time Worked
Conference Dates Requesting
Total # Conference Days Requesting
Support Raising Dates Requesting
Total # Support Raising Days Requesting
"Other" Dates Requesting
Total # "Other" Days Requesting
Notes
Date(s) Returning to Work
Have you made arrangements for someone to cover for you? If yes, who?
In case of emergency, how can you be reached?
Submit
Should be Empty: