Distribution:
COPY 1/ Employee; COPY 2/School/Office; COPY 3/Funding Source Office; COPY 4/(if Part E applies) Chief Financial Officer
MCPS Form 430-94
March 2017
Page 1 of 2
Professional Leave (PRO)
Office of the Chief Financial Officer
MONTGOMERY COUNTY PUBLIC SCHOOLS
Rockville, Maryland 20850
INSTRUCTIONS: This form is used to request and approve professional leave (PRO) for less than 5 days. Appropriate documentation
must be attached.
PARTS A–C to be completed by employee requesting professional leave and forwarded to the appropriate supervisor
for approval prior to the date of the activity.
PART A: EMPLOYEE REQUEST
Name of Employee
Employee ID #
Work Location ________________________________________________________________________________________________________
Number of Days (or) Hours Half day or less □ A.M. □ P.M.
Dates of Leave / / through / /
Activity Details/Reason for Leave (specify activity/program, location, time, etc.; attach supporting documentation)
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Type of Professional Leave Activity:
□ Training □ Conference □ Curriculum Development □ Meeting □ Field Trip □ School Improvement
□ Other School Activity □ Other __________________________________________________________________________________
Substitute Required? □ No □ Yes (If Yes, complete Part B) Name of Pre-arranged Substitute ________________________________
Substitute Employee ID #____________________ Substitute Job Number____________________
PART B: SUBSTITUTE FUNDING
(Must be completed if substitute is required. Check one funding source below and provide applicable information.)
□ School IAF: Account Name _________________________________________ Account No._________________________________
□ MCPS Central Office/Operating Funds Account Number/Code _______________________________________________________
Sponsoring Office _________________________________________ Contact Person________________________________________
□ Outside Agency or Grant: Name _________________________________________________________________________________
Address ________________________________________________________________________________________________________
Contact Person _________________________________________________________________ Phone Number _____-_____-______
PART C: EMPLOYEE CERTIFICATION
Has honoraria been offered for work completed during this professional leave? □ No □ Yes If yes, complete Part E on page 2
Employee Signature ______________________________________________________________________________ Date ____/____/______
PART D: AUTHORIZATION
Approval of this leave request meets the following criteria:
□ MCPS Definition of Professional Leave
□ School/Office needs
□ Available Funding has been confirmed (if substitute or other fees are required)
□ Approved (must meet all three criteria)
□ Not approved, reason ______________________________________________________________________________________________
Principal/Supervisor Signature _____________________________________________________________________ Date ____/____/______
PART D to be completed by principal/supervisor
