1) Today's Date:   (i.e. Jan. 1, 2002):

  2) Your Name: 

  3) E-mail Address: 

  4) Type of Leave: ... Vacation Medical - Personal Medical - Family Jury Duty Other    

              If "Other" please specify:

  5) Specific Dates Requested (One date per box - i.e. Nov. 24):

          

          

  6) Total Hours Requested:    (one day = 7.5 hrs)

  7) Comments / Additional Information:

       

Please make sure everything in the above fields is as accurate as possible BEFORE you submit your request. Inaccurate or incomplete information may result in your request not being approved.

This request will be sent to Missy Bryant.

Once your request is submitted, you will receive a reply e-mail indicating whether your request has been approved, with any amendments and/or comments as necessary.