Hopkinsville Community College
KCTCS
Professional Leave Request / Record
Date:
Name: Employee ID #:
Leave Requested From: Through:
Account Name: Amount:
Account Name: Amount:
From (Origin): To (Destination):
My Address(es) and Telephone Number(s) will be:
Purpose: (Do not
abbreviate organizational
names.)
Mode of Travel:
(Check One)
Personal Auto College Vehicle Colleague Airplane Other
If expenses are being paid through Professional Development, attach signed statement of approval.
Estimated Expenses
Registration: *
Yes No
Pre-Paid Registration:
*Receipts Required
Lodging*
Mileage
Airfare*
Miscellaneous
Parking*
Ground Transportation
TOTAL
Other:
Check One:
Traveling and Requesting Expenses
Traveling and NOT Requesting Expenses
Traveling with students for an instructional activity.
Traveling with students for a student activity.
All information needed for insurance on students
has been coordinated with the Business Office.
Travel with Students: Check all that apply:
Approved:
Distribution: Original to Human Resources; Copies to Requestor, Requestor's Supervisor, and Department Budget Contact
$
$
$
$
$
$
$
Meals
$
$
$
Requestor
Immediate
Supervisor
Dean / CAO
President
Print Form
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit