Leave Request Form

Leave Request Form
Employee Name

First NameLast Name
Type of leave requested
School / Location
Supervisor
Reason for leave
Provide details/description as appropriate
If this leave requires a long term substitute for your position, indicate who the substitute will be.
Length of Leave Request
You can find the number of personal and sick days you have available on the iVisions Web Portal.
How many personal days do you have available to use?
How many sick days do you have available to use?
How many personal days do you wish to use for this leave request?
How many sick days do you wish to use for this leave request?
The remainder of days will be leave without pay.
Date leave to start

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of anticipated return to work

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email (Enter your email twice for confirmation)

Confirmation Emailexample@example.com
Please verify that you are human
Should be Empty: