Teacher Absentee Form
School
Name: ___________________
I CERTIFY THAT I WAS UNABLE TO TEACH SCHOOL ON THE FOLLOWING DAY(S).
DATES
Please deduct day(s) from my SICK LEAVE.
day(s) from my PERSONAL/PROFESSIONAL LEAVE.
Please deduct (You have three (non-tenure) or four (tenure)
Substitute Teacher: SSN #
Address:
City State Zip
I certify that the above statements are true.
Teacher
Signature
Principal
Signature
Sick Leave Allowed - "Sick Leave" shall mean leave of absence because of: Illness of a teacher from
natural causes or accident, quarantine, or illness or death of a member of the immediate family of a
teacher, including the teacher's wife or husband, parents, grandparents, children, grandchildren,
brothers, sisters, mother-in-law, father-in-law, daughter-in-law, son-in-law, brother-in-law, or sister-in-
law, however, upon written request of the teacher accompained by a state from her physician verifying
pregnancy, any teacher who goes on maternity leave shall be allowed to use all or a portion of her
accumulated sick leave for maternity leave purposes "during the period of her physical disability only, as
determined by a physician." TCA 40-1314 as amended by Chapter 70 of the Public Acts of 10.
PLEASE CHECK APPROPRIATE REASON:
Personal Illness
Illness-Member of Family
Name of Relative
Death - Member of Immediate Family
# Bereavement Days
Family Relation
Please pay the above named substitute teacher for day's taught.
Hampton Elementary School
Teacher Absentee Form
e purposes "during the period of her physical disability only, as
Hampton Elementary School