Time Off Request Form

Step 1: Submit this the Leave Request Form

Complete this form for any absence 2 hours or longer, regardless of whether you’re using PTO.

Step 2: Request PTO in Gusto (if applicable)
If you want the time off to be paid, submit a request in Gusto.

Role-Specific Guidance
Counselors

Submit the form for all absences of 2+ hours or to request PTO
No form needed for schedule adjustments under 2 hours. Unless specfically requested by admin team.
Block calendar only after approval

Administrative Staff

Submit the form for all absences, regardless of length

Notice Requirements

5+ consecutive days off or more: Request at least 30 days in advance
Less than 5 days: Provide at least 2 weeks’ notice
Emergencies or last-minute absences: Will be reviewed case by case
If your leave request falls outside this window it will be considered unplanned leave.

Employee Name*

First NameMiddleLast Name

Start Date*

MonthDayYear

End Date*

MonthDayYear

Type of Leave Request*

PTO (Paid Time Off) Time off request within the required notice period (e.g one week for one or more days and one month for 5 or or more)Unpaid Time Off Time off request within the required notice period. But no PTO is available in Gusto or the employee does not want to use their PTO.Unplanned Leave (Using PTO) Time off request NOT within the required notice period. The employee would like to use PTO. Approval will be evaluated case by case (e.g., sick leave, unforeseen circumstance).Unplanned Leave (Not Using PTO) Time off request NOT within the required notice period. The employee is NOT requesting to use paid time off (e.g., sick, leave, unforeseen circumstances).

Total Number of Hours Requested*

If using PTO, you are required to make a request in Gusto as well? Did you do so already?*

YesNoN/A

If using PTO, how many PTO hours of your PTO would you like to use? Put N/A if not using PTO*

For additional notes related to this leave request.

Reason*