Time Off Request Form

Time Off Request

I would like the following dates off.

Today's Date

First Name

Last Name

Parent / Guardian Name

Single Day Off Request

If you want to take one day off or a few days off that aren’t next to each other, use this part.

Single Date 1

Single Date 2

Single Date 3

Single Date 4

Multiple Days Off (Vacation) Request

If you’re taking a few days off in a row, like one after the other, use this part. Pick the first day you’ll be off and the last day you’ll be off, like the start and end of your vacation.

First Day of Vacation #1

Last Day of Vacation #1

First Day of Vacation #2

Last Day of Vacation #2

First Day of Vacation #3

Last Day of Vacation #3

Staff Coverage

Have you contacted anyone to sub for you?

Yes, I have Not yet

If so, who have you contacted and what was their response?