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ABSENCE REQUEST

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					                                 WINFIELD INDEPENDENT SCHOOL DISTRICT
                                  ABSENCE-FROM-DUTY/REQUEST REPORT


FORM MUST BE SUBMITTED IMMEDIATELY UPON RETURN TO DUTY
* For discretionary leave, this form must be submitted 3 days prior to leave for approval

Discretionary personal leave is not permitted in the following instances:
the day before or after a school holiday
days scheduled for end-of semester exams or end-or year exams
days schedule for TAKS testing
professional or staff development days

If you have used all your accured leave, dicretionary leave MAY NOT be approved

* Personal who have exceeded days of accurred leave, will be docked in accordance with their contract requirements

* Absent of 5 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 for more than five days must schedule a
conference with personnel office.

* Leave request will be granted in accordance with board policy DEC.




NAME:                                                                       DATE REQUESTED:

           REASON FOR ABSENCE                                               DATE(S) OF ABSENCE TOTAL DAYS ABSENT

  Personal illness or medical appointment
 Illness or medical appointment in family
Specify relationship:
   Death in Family
Specify relationship:
   Emergency
Specify:

   Personal Business

   Jury Duty or Subpoena (attach documents)

  School Business:

   Other

EMPLOYEE SIGNATURE:                                                         DATE:


PRINCIPAL SIGNATURE:                                                        DATE:


SUPERINTENDENT SIGNATURE:                                                   DATE:


  LOCAL                              STATE

				
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