Coconino Community College Community Leave
Partner Request
(submittoHRwhencomplete)
OrganizationName:
OrganizationAddress:
Orga
nizationPhone/Email:
OrganizationContact:
Doestheorganizationholda501‐c3non‐profittaxstatus?Yes No
BrieflyDescribewhattheorganizationdoes(Mission/Goals):
Submittedby:(PrintName&Jobtitle)
DateSubmittedtoHR:
ReceivedbyHR:
ApprovedorDeniedbyHR(ReasonwhyDeniedtobeincluded)