Fillable LeaveRequestcoe - 09_10_faculty_manual_NO_PAGES_NUMBERS

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LeaveRequestcoe - 09_10_faculty_manual_NO_PAGES_NUMBERS

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Other:
Jury Duty
Funeral Leave
Relationship: ______________________
Personal Leave without pay
Sick Leave without pay
Richard W. Riley College of Education
Winthrop University
106 Withers Building
Rock Hill, SC 29733
REQUEST FOR LEAVE
NAME
SOCIAL SECURITY NUMBER
DEPARTMENT
DURATION OF LEAVE:
From: _______ a.m. ____ /____ /____
Through: ______ a.m. ____ /___ /____
Hours: ________ Minutes: __________
p.m.
p.m.
Type of Leave Requested (Check one):
Annual Leave
Sick Leave with pay — employee
Sick Leave with pay — family
Signature Date
Approval Date
***Please submit to Department Chair/Director
104
Month / Day / Year
CLEAR ALL LINES
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LeaveRequestcoe - 09_10_faculty_manual_NO_PAGES_NUMBERS

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Completed 8 February 2020

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