Request for Time Away

Internal Use Only

General Information
Member:
Name:
Dates Requested Off: FROM: (First Day off)

TO: (Last Day Off)

Type of Leave:
Vacation
Sick
CME
Other
Presentation of Officer at National/ State Association (Requires Chair approval for additional days)
Meeting:
Presentation Topic:
Office Held:
Location:
Dates:
(National - up to 5 additional days/year) (State - up to 2.5 additional days/year) TOTAL of 5 days per year
Comments:

Please note that all requests must be approved in writing by your Supervisor.

I understand that requests will be considered by my supervisor and in the event that my request is denied, I will be notified.