Teacher:

Date(s) To Be Absent From School:

Purpose of Leave:

Estimated Cost

Estimated Costs:                                                    Funding Source: (Office Only)

Registration:                            

         Travel:                             

         Meals:                             

      Lodging:                             

   Substitute:                             

Total:                

Approved:_____________     Disapproved_____________

Comments:_________________________________________________________

___________________________________________________________________

___________________________________________________________________

______________________________Principal's Signature

______________Date

For professional conferences, please attach copies of the agenda to this request.