APPLICATION FOR PROFESSIONAL LEAVE

							                             APPLICATION FOR PROFESSIONAL LEAVE

        This form must be received by the committee in time to be processed and in time for the
committee to give the required five school days prior notice to the building principal. The day of the
activity and the day of the meeting do NOT count in those five days. Committee meetings are on
Wednesdays. This means that the earliest approved activity could be Thursday of the week following the
meeting at which the leave is approved. Please include years in your dates. Thanks!

Name_____________________________________________ School _____________________________

Grade level you teach_____________________ Position_______________________________________

Purpose of leave _______________________________________________________________________

Date of the meeting ____________________Location of the meeting _____________________________

Number of days requested _______________ Dates requested ___________________________________

Number of days of professional leave you have been granted for the current year ____________________

Were you asked by an administrator to attend this function? _____________________________________

Are you being paid more than expenses for participation in this activity? ___________________________

Will a substitute be required in your absence? ________________________________________________

Are students accompanying you to this function? _____________________________________________

Is documentation for your request attached? (Copy of registration, flyer advertising the activity) ________

It is your responsibility to notify the committee in writing if you do not use the days granted to you for this
purpose. Please do so as soon as your plans are cancelled so the days may be awarded to others who may
need them. Thanks!


_____________________________________________________________________________________

Committee Action

Date received by committee member _______________________________________________________

Date of committee action ________________________________________________________________

Leave granted __________ or denied _____________ or pending additional information _____________

If denied or pending, reasons for such action _________________________________________________

_____________________________________________________________________________________

Appeal date or date for reconsidering pending leave ___________________________________________