Employee Request For Professional Leave
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1PERSONNEL
03.19 AP.21
Employee Request for Professional Leave
Name _____________________________________________ Date ____________________________
School/Department __________________________________
Position __________________________
I request professional leave on the following work days: ________________________________________
Nature: ___________________________________________
Location: _________________________
(Attach agenda or conference information)
Student Trips
Employee Only
In-State-Within 150 miles of school
In-State
□
□
(requires Principal & Superintendent/Designee approval)
(requires Superintendent/designee approval)
Out-of-State, overnight, or excess of 150 miles from school
Out-of-State or Overnight
□
□
(requires Board approval)
(requires Superintendent/designee approval)
Approximate # of students attending: _____________
Bus Requested?
YES
NO
Estimated Costs/Expense reimbursement requested (Policies 03.125/03.225)
Failure to complete expense request could result in delay of approval.
Conference Registration
$
$
Estimated Travel Cost: select mode of travel and indicate mileage or ticket cost:
Personal auto
Passenger (no cost)
Airplane
School Vehicle($1/mi.)
School Bus
Other______________________
Estimated Hotel Cost: _____ # of nights X
room rate (list split rate if sharing room)
$
Estimated Meal Per Diem (Meals cannot be reimbursed for “day” trips.)
$
$
List other costs (e.g. parking fees, taxi fares, checked luggage)
Substitute Required?
YES
NO
Estimate $100 per day
$
Estimated Total Cost
$
0
(select all that apply)
School Instructional Funds
School Activity Funds
Funding Source:
Grant Name_______________
Other_________________
District Funds
Funding Code(s):
_______________________________________
_____________________________________________
_
Employee
Immediate Supervisor (if approved)
__________________________________________________________________________
Signature of Superintendent/Designee
All professional leave must be approved in advance by the Superintendent/Designee and/or Board. The
original copy of the signed form should be attached to the Service Report.
RELATED PROCEDURES:
03.125 AP.21; 03.125 AP.22
Review/Revised: 5/26/2015
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