LEAVE OF ABSENCE REQUEST FORM
Request your leave details down below.
LEAVE OF ABSENCE REQUEST FORM
Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Reason for LOA
*
Medical
Military
Jury Duty
CBD Employee Recommendation
Other (explain below)
If you selected "Other" provide explanations here
Do You Plan On Returning?
*
Yes
No
Is Student Meeting Satisfactory Academic Progress (Manager Answers)
Yes
No
Details of Leave
Leave Request For
Days
Leave Start
*
-
Month
-
Day
Year
Date Picker Icon
Leave End
*
-
Month
-
Day
Year
Date Picker Icon
Comments
Student Signature
*
Instructor/Manager Name
*
First Name
Last Name
Instructor/Manager Signature
Request Leave
Should be Empty: