Absence Request

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First Name*

Last Name*

Western Email*

Supervisors Name*

Supervisors Email*

Start Date*

End Date*

Number of Days (if applicable)

Number of Hours (if applicable)

Type of Absence* Please Select Personal Time Sick 1/2 Staff Negotiated Day Bereavement Vacation Lieu Time Leave of Absence Jury Duty Maternity/Parental Leave Compassionate Care Ransom Daye Other (please explain in the comments)

Comments

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