Hartford School District Personal/Emergency Day Request Form
Personal/Emergency Day
Personal Leave
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.
Emergency
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?
*
First Name
Last Name
What is your Hartford School District email?
*
example@example.com
What is today's date?
*
-
Month
-
Day
Year
Date
What type of day are you requesting?
*
Personal Day
Emergency Day
Reason for request of Emergency/Bereavement Leave:
Who is your school administrator, supervisor, or program coordinator?
*
Amelia Donahey
Rick Dustin-Eichler
Doug Kussius
Erica Rogstad
Doug Heavisides
Nelson Fogg
Cody TanCreti
Erika Schneider
Mary Bouchard
Jonathan Garthwaite
Caty Sutton
What day or days are you requesting?
*
Half Day/Full 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.
Submit
Should be Empty: