Form L-2 - Request For Educational Leave Of Absence printable pdf download

REV 7/13

L-2

METROPOLITAN NASHVILLE PUBLIC SCHOOLS

REQUEST FOR EDUCATIONAL

LEAVE OF ABSENCE

The purpose of this leave is to allow the employee to retain benefits such as insurance, accumulated leave and continuity of service. However,

it should be noted that the District can grant leaves only for specified periods of time. Educational leaves are granted to employees up to one

(1) year. Five (5) years of service or more are required for educational leaves. Documentation or enrollment/registration is required for

Educational leaves as well as class schedule and proof of tuition payment. Full time employment is not allowed while on Educational Leave.

You will need to contact the Employee Benefits office (259-8644 or 259-8484) for information regarding your insurance and benefits.

NOTE: THERE IS NO PAY FOR EDUCATIONAL LEAVE.

THIS COMPLETED FORM L-2 MUST BE SUBMITTED TO THE OFFICE OF EMPLOYEE BENEFITS AND APPROVED BEFORE THE LEAVE IS TAKEN.

Please answer all questions as completely as possible as inadequate information can delay processing.

SECTION I – (TO BE COMPLETED BY EMPLOYEE)

(Please Print)

Name _________________________________________ Employee # ______________Phone _________________

Address _______________________________________________________________________________________

(Street)

(City/ST)

(Zip)

School/Location ___________________________________________________ Title _________________________

Date Requesting to Begin Leave _________________________ Return Date _______________________

College or University: ___________________________________________________________________________

Course of Study: _______________________________________________________________________________

Employee Signature: ____________________________________________________Date ____________________

SECTION II (TO BE COMPLETED BY THE PRINCIPAL/DEPARTMENT SUPERVISOR)

I Acknowledge the Following Request for Educational Leave From __________________To ___________________

Comments: _____________________________________________________________________________________

Principal/Supervisor ___________________________________Title __________________________Date _________

Signature

SECTION III – (TO BE COMPLETED BY HUMAN CAPITAL)

APPROVAL STATUS:

( ) Leave is Approved

( ) Leave is NOT Approved

LEAVE DATES APPROVED From: ______/_______/_______ To: _______/_______/_______

Comments: _____________________________________________________________________________________

Approval Signature __________________________________________________ Date ________________________

EMPLOYEES MUST NOTIFY EMPLOYEE BENEFITS IN WRITING OF THEIR AVAILABILITY TO RETURN TO ACTIVE SERVICE

TWO WEEKS IN ADVANCE OF THEIR RETURN DATE

PLEASE RETURN FORM TO METROPOLITAN NASHVILLE PUBLIC SCHOOLS EMPLOYEE BENEFITS

2601 BRANSFORD AVE  NASHVILLE TN 37204  FAX 615/214-8665

QUESTIONS CALL 615/259-8410 or 259-8641

Form L-2 - Request For Educational Leave Of Absence