Education Leave Request

Employee Name

Date

Title of course, class or seminar

Name of college, institution or sponsor:

Dates for class or semester enrolled

Please Read:

-I understand that this request is subject to Department approval. -I understand that I may not exceed 72 hours of Educational Leave per Fiscal Year. -I understand that Education Leave may not be combined with other types ofleave during the same shift.

Please attach a copy of your class registration.

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 50 MB.

Please Read:

TEL: (623) 974-2321