Employee Time Off Request Form
Name
*
First Name
Last Name
Email
*
example@example.com
Your Division
*
Lower School
Middle School
Upper School
Departmental Staff
Department
Please Select
Admissions
Communications
Development
Business Office (including Finance, HR, Facilities, and Nurse Office)
IT
K-12 Educational Coordinators
Auxiliary Programs
Days or Hours of Leave
*
Full Day
Hours (less than a full-day)
Back
Next
First Day Out of Office
*
-
Month
-
Day
Year
First Day Off
Last Day Out of Office
*
-
Month
-
Day
Year
Last Day Off
If out for less than a full day, please put the time you will be leaving.
Hour Minutes
AM
PM
AM/PM Option
If out for less than a full day, please put the time you will be returning.
Hour Minutes
AM
PM
AM/PM Option
Total Hours Requested
For example: 1.5 days or 1 day + 2 hours
Helpful Notes
Reason for the Time Off
*
Medical
Discretionary (Personal)
Bereavement
Jury Duty
Professional Development
Vacation
Is this request for FMLA leave
Yes
Name of Substitute (if applicable)
Phone Number of Substitute (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: