Leave Request/Callout form

Student ActivitiesLeave Request/Callout form

Please use this form if you are requesting vacation, early leave, sick leave, calling out, or will be more than one hour late.

Date of Submission Date of Submission / MM / DD YYYY
Name Name First Last
Phone Phone - ### - ### ####
Email
Request
Callout
Date: From Date: From / MM / DD YYYY

Please indicate the date for all requests and callouts.
Date: To Date: To / MM / DD YYYY
Time: From Time: From : HH MM AM/PM

Please indicate time for In Late and Early Leave requests and callouts.
Time: To Time: To : HH MM AM/PM
Supporting Documentation

Maximum file size: 3MB.

Attach Files

A doctor's note is required for three or more consecutive sick days or an excessive pattern sick days. You may upload the note or bring it to the office upon return.