Professional Leave Request

Professional Leave Request
Your Name

First NameLast Name
Date Request was Submitted

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your E-mail
NAME AND DESCRIPTION OF PROFESSIONAL DEVELOPMENT ACTIVITY:
LOCATION OF PROFESSIONAL DEVELOPMENT ACTIVITY:
Number of overnight stays required:
Number of days attending conference:
Day 1

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Day 2

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Day 3

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Day 4

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Day 5

MonthDayYear
2 digit month, 2 digit day, 4 digit year
ESTIMATED EXPENSES TO BE INCURRED:
Miles
Enter Total Estimated Miles
Est. Mileage Expense
Auto-Calculated
MEALS: MEALS WILL ONLY BE REIMBURSED ON OVERNIGHT TRIPS. YOU MUST SUBMIT DETAILED MEAL RECEIPTS TO BE ELIGIBLE FOR REIMBURSEMENT. ONLY MEALS OF CO-OP EMPLOYEES ATTENDING THE PROFESSIONAL DEVELOPMENT ACTIVITY WILL BE REIMBURSED. THE CURRENT LIMIT IS $35 PER DAY.
Meals
# of days
Estimated Meal Expense
Auto-Calculated
LODGING: PLEASE COORDINATE TRAVEL AND LODGING ARRANGEMENTS WITH OTHER EMPLOYEES WHO MAY BE REQUESTING THE SAME PROFESSIONAL ACTIVITY.
Lodging
Enter Name of Hotel
Lodging Expense
Enter Estimate for Lodging
Registration
Enter Description of Fees
Registration Expense
Enter Total for Registration
Total Estimated Expense
Which TEAM LEADER approved the submission of this request?
Team Leader Email
YOU WILL BE CONTACTED ONCE THIS PENDING PROFESSIONAL DEVELOPMENT ACTIVITY IS APPROVED.
Should be Empty:

Professional Leave Request

ESTIMATED EXPENSES TO BE INCURRED: