WINFIELD INDEPENDENT SCHOOL DISTRICT
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
Death in Family
Jury Duty or Subpoena (attach documents)
EMPLOYEE SIGNATURE: DATE:
PRINCIPAL SIGNATURE: DATE:
SUPERINTENDENT SIGNATURE: DATE: