Administrator Staff Absence
Admin Staff Absence

First Name:  Last Name: 

Email Address: 

Report Date: 

Date(s) of Absence: 

Reason for absence (Check one):

Personal Leave

Bereavement

Illness

Medical Leave

Professional Leave

Vacation

Without Pay

Other

Other Explanation (to be filled out only if other box is checked): 

Reason for Absence: 

I hereby apply for leave of absence    I have been absent on the following dates:

Beginning (first day of absence) Ending (last day of

absence)  Total work days: 

__________________________________________________________

For administration use only:

Approved                                Disapproved

Administrator's name: 

Date: 

___________________________________________________________

 

 

 

 



Security Measure