Time Off Request

Time Off Request

Please fill out the form below for EACH PERIOD OF CONSECUTIVE TIME you request to be off.
Staff Contact Information

The response to your time off request will be sent to the contact you enter below.
Name*
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Time Off Request
Types of Time Off

Selected Time Off: Up to 3 weeks selected by staff member in addition to the 3 weeks of scheduled time off. Full-time staff are eligible.

Support Raising Furlough: Up to 4 weeks off for solely for the purpose of support-raising. Full-time staff are eligible after two years of service.

Sabbaticals: 3 months off after seven years of full-time staff service.

Leaves of Absence: Special requests such as materity/paternity, caretaking, medical, disability, or bereavement.

Special Opportunity: Any personal time off that extends beyond the total allotted 6 weeks (scheduled + selected).
Select the Type of Time Off requested:*

Selected Time Off (up to 3 weeks)Support Raising Furlough (up to 4 weeks)Sabbatical (3 months)Leave of AbsenceSpecial Opportunity
Date From:*

MonthDayYear
Date
Date To:*

MonthDayYear
Date
How many work days are you requesting to be off?*
How firm are the dates you entered?*

01 - Hard plans, unable to change dates or duration02 - Firm plans, difficult to change dates or duration03 - Flexible plans, dates and duration are preferred04 - Loose plans, dates and duration can change
From your perspective, will your responsibilities need to be covered or delegated while you are away?*

01 - No, all my responsibilities will be well maintained during that period without the need for covering.02 - Yes, some of my responsibilities will need to be covered.03 - Yes, My entire role and all of my responsibilities will need to be covered.
In order to help the review and approval of your request, please describe the reason and any details of your requested time off. Thank you.*
Should be Empty:

Time Off Request

Staff Contact Information

Time Off Request

Types of Time Off