Request for Leave Form
Academic Affairs Technology
Wilder Tower Room 001
Name:
I hereby request leave commencing at :
On / /
  Month Day Year
And extending through :
On / /
  Month Day Year
For : (stated in hours and tenths of hours).  
This constitutes: Annual Leave
  Sick Leave (includes personal doctor appointments, personal dental appointments, and maternity related absences, family illness, etc.)
 
Comments:
Requested by: _____________________________ Date: ___ / ____/ ____
 
Approved by: _____________________________ Date: ___ / ____/ ____
Note: Partial hours are as follows: 1 - 6 min = .1 hr.
  7 - 12 min = .2 hr.
  13 - 18 min = .3 hr.
  19 - 24 min = .4 hr.
  25 - 30 min = .5 hr.
  31 - 36 min = .6 hr.
  37 - 42 min = .7 hr.
  43 - 48 min = .8 hr.
  49 - 54 min = .9 hr.
  55 - 60 min = 1 hr
For request of Annual Leave, please complete request before the leave begins.
For Sick Leave complete form on first workday after absence.

Last Updated: 11/29/12