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.