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Request for Personal Leave
7/31/2005

REQUEST FOR PERSONAL LEAVE

COFFEE COUNTY SCHOOL SYSTEM

Name _______________________________ Date request is submitted__________________________

PLEASE CIRCLE: This request is for day: 1 2 3 4 5

DATE(S)

REQUESTED

A.M.

P.M.

ALL DAY

A.M.

P.M.

ALL DAY

REASON FOR REQUEST: (Please complete is request is for 3rd, 4th, or 5th day of personal leave.)

FOR OFFICE USE ONLY

Your request has been:

Approved

Disapproved              Principal’s Signature_________________________________________

Approved

Disapproved              Superintendent’s Signature____________________________________

PLEASE NOTE

The Superintendent’s signature is required for the first two days only when the proposed leave day(s) are immediately or subsequent to school holidays or during the first or last week of school.

The Principal’s and Superintendent’s signatures are required when taking the 3rd, 4th, or 5th day.

ALL requests must be submitted prior to using leave.