Hartford School District Personal/Emergency Day Request Form
Three (3) days per year will be granted as personal days without loss of pay. Except in the case of emergencies, notification to the staff member’s immediate administrator shall be made at least 2 business days in advance. Personal days shall be for the express purpose of attending to those needs not readily accomplished at other times; including attending family obligations and special events (e.g., weddings, class reunions, graduations, mortgage closing, and religious holidays); childcare emergencies; natural events that prevent transportation to school, etc. No reason need be stated. No personal days will be granted immediately before or after a vacation period or the Thanksgiving break unless the Superintendent determines that extenuating circumstances prevail. At the end of each school year, unused Personal days will be added to the number of accumulated sick days.
If a staff member has used three Personal days and extenuating circumstances exist, a staff member may request additional leave from the Superintendent or his/her designee.
Bereavement Leave Three (3) per year may be granted without loss of pay for bereavement and attendance at funerals. The Superintendent must approve payment for all bereavement days taken. Requests for additional bereavement days in any one year shall be made to the Superintendent or his/her designee.
What is your name?
What is your Hartford School District email?
What is today's date?
What type of day are you requesting?
Reason for request of Emergency/Bereavement Leave:
Who is your school administrator, supervisor, or program coordinator?
What day or days are you requesting?
Half Day/Full Day
Half Day AM
Half Day PM
Please sign your name (as best you digitally can).
Please do not write anything in this space. This is for Administrator or Superintendent approval of your request.
Should be Empty: