Danville Area Community College
Leave Share Program Request Form
Recipient’s Information
Name of Employee: Colleague Number:
Leave Information
First Day Absent:
Has FMLA papers been filed with HR?
Yes No
Number of Days Requested:
Employee Signature or Requested by:
Human Resources
Reviewed by Committee: Date Reviewed:
Approved Denied
Number of days granted:
Date Transferred from Leave Share Bank to Employee:
Human Resources Signature: Date: