Time Off Request Form
Name
*
Please Select
Adina Golombeck
Ahuva Brown
Aliza Coleman
Ana Roque
Avital Rubin
Batsheva Perlman
Chana Perel
Chana Rivka Lewis
Chani Blesofsky
Chanie Koster
Chava Parnes
Chaya Gross
Chaya Nulman
Dassie Nierman
Emily Pared
Goldee Benlolo
Hadassa Pam
Hanna Yaffe
Libby Buxbaum
Lizbeth Cruz
Michal Spero
Miriam Esral
Miriam Gowar
Naomi Perel
Naomi Selevan
Nechama Halpern
Nicole Oved
Penina Golombeck
Peshie Goldberg
Raquel Lexier
Rechyl Sirota
Rena Wachsman
Rivka Friedman
Rivka Hauser
Rochel Frank
Sara Rubin
Sarah Klein
Sarah Sentell
Shira Segelman
Sorah Stoll
Tova Daum
Tzippy Brenner
Email
*
example@example.com
Request Type
*
Schedule Change
Time Off
Location Change
When will you be making up the time?
*
Please include date, time & time zone
Please indicate your location, time zone, and work setup.
*
Supervisor
*
Please Select
Mrs. Rivka Friedman
Mrs. Sarah Klein
Mrs. Dassie Nierman
Mrs. Nicole Oved
Mrs. Hadassah Pam
Mrs. Batsheva Perlman
Mrs. Naomi Selevan
Mrs. Sarah Rubin
Mr. Yigal Sasportas
Department
*
Please Select
Admin
Business Office
Development Office
Human Resources Office
Tuitions Office
IT
Supervisor Email
*
example@example.com
Reason for {requestType}
*
Start Date (Time should be in CST)
*
-
Month
-
Day
Year
Date
Hour Minutes in CST Minutes
AM
PM
AM/PM Option
End Date (Time should be in CST)
*
-
Month
-
Day
Year
Date
Hour Minutes in CST Minutes
AM
PM
AM/PM Option
Please Approve or Deny the request
*
Please Select
Approve
Deny
Reason for denied request
*
Submit
Should be Empty: