Bemidji Regional Interdistrict Council
REQUEST FOR LEAVE
Name: ________________ Date:
Type of Leave Requested:
_____ Sick ______ Professional _____ Leave w/o Pay
_____ Personal ______ Bereavement _____ Vacation
Explanation:
____________________________________________________________________________________________
Date(s) of Absence: _________________ Total Days:
Will a substitute be needed, or in case of sick leave, was substitute needed? ____________
PROFESSIONAL LEAVE:
Please estimate expenses and attach registration form & workshop/conference description.
______ I will register myself. ______ Please register me for this workshop/conference.
If lodging is necessary: ______ I will arrange my own lodging. ______Please arrange lodging for me.
Transportation: _______________________
Lodging & Meals: ___________________________
Registration: __________________________
| _____ Approved with Pay _____ Approved without Pay _____ Not Approved Program Supervisor: ___ Date: _ __________ |
_____ Approved with Pay _____ Approved without Pay _____ Not Approved Director: ____________ Date: ____________ |