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District Forms

Secondary Absence Request Form

April 01, 2007

  • For discretionary leave, this form must be submitted for approval prior to the time you are requesting to be absent from duty. Request for more than two days must be approved by the superintendent. Form must be submitted immediately upon return for all other leave.
  • Absences of 3 or more consecutive days for personal or family illness must have a written statement from a health care practitioner attached.
  • Employees requesting or reporting extended leave of more than five days must schedule a conference with their supervisor.
  • Leave requests will be granted in accordance with board policy DEC.
Campus 
Name  SSN 
Email address 
REASON FOR ABSENCE DATE(S) OF ABSENCE TOTAL DAY(S)
indicate full or half
 Personal illness or medical appointment
    Illness or injury work-related
 Illness or medical appointment family
   Specify relationship: 
 Death in family
   Specify relationship: 
 Emergency
   Specify: 
 Personal Business
 Leave to care for newborn child (or placement of a child)
 Jury Duty or Supoena
 Off Duty Days
 Workshop / Field Trip
   Title: 
 UIL Activity
   Specify: 
This is to certify that I was absent from duty on the date(s) shown above and for the reason(s) indicated. I understand that the reason for absence from duty cannot be changed after submitting to the Central Office.

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