Date/Time Received:______________ (Office Use Only)

Name:

Date(s) Requested: 

Reason(s) for Request:

Approved____      Disapproved _____

Principal: _______________________________Date:_____________________

 Reminders:

1.   Requests for personal leave should be submitted two weeks in advance.

2.   Requests for personal days cannot be approved for a day before/after or during the first/last week of the school year.  Special circumstances should be discussed with the principal, requested in a letter, and must be approved by the superintendent.

3.   Time should be allowed for processing the requests.

4.   The number of personal days approved for a particular school day may be limited to five (5).

 Comments _________________________________________________________

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