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
click to sign
signature
click to edit
click to sign
signature
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click to sign
signature
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click to sign
signature
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