| Sheepscot Valley School Union # 133 | |||||||||
| 69 Augusta Road | |||||||||
| Whitefield, ME 04353 | |||||||||
| Telephone: (207) 549 - 3261 FAX: (207) 549-3082 | |||||||||
| REQUEST FOR LEAVE FORM | |||||||||
| Teacher | |||||||||
| Support Staff | |||||||||
| Date Submitted | |||||||||
| Name: | Position: | ||||||||
| (please print) | |||||||||
| School | o | Windsor | o | Palermo | o | Somerville | o | Union | |
| Type of Leave | With Pay | W/O Pay | |||||||
| a. | Professional Leave | o | o | ||||||
| b. | Beareavement Leave * | o | o | ||||||
| c. | Jury Duty | o | o | ||||||
| d. | Personal Leave | o | o | ||||||
| e. | Leave of Absence | o | o | ||||||
| f. | Other-Vacation, etc. | o | o | ||||||
| * | Bereavement Leave - please indicate relationship to deceased | ||||||||
| Substitute Needed? | o | Yes | o | No | o | Half day | |||
| o | Full day | ||||||||
| Dates Requested | |||||||||
| Funding source: | |||||||||
| (Staff member signature) | (Date submitted) | ||||||||
| (Principal Approval) | (Date received) | ||||||||
| Conference Information: | |||||||||
| Cost of Conference: | |||||||||