Full Name:
Type of Leave:	Choose One Bereavement Leave Personal Leave Professional Leave Sick Leave
Cause for Leave:	Choose One Self Spouse Child Parent Grandchild Grandparent Other Not Applicable
Date(s) of Absence:
Specify Days or Hours:	Choose One Days Hours
Number of Days / Hours Requested:

Additional Comments:

Employees should request personal leave at least one week in advance and professional leave at least two weeks in advance.

For sick or bereavement leave, please include the "cause for leave" information.