Leave Request Form v2

Leave Request Form
Date *

Month Day Year
Date
Name *

First Name Last Name
Employee Status *
Employee Type *
For any impacted courses, are you cancelling course sessions or scheduling a substitute? *

I am cancelling course sessions. I have or will have a substitute scheduled.
Requested Time Off
Type of Leave
If leave is unpaid please describe.
Dates Requested *
Number of Hours *
Type of Leave
Dates Requested
Number of Hours
Type of Leave
Dates Requested
Number of Hours
Type of Leave
Dates Requested
Number of Hours
Type of Leave
Dates Requested
Number of Hours
Type of Leave
Dates Requested
Number of Hours
Type of Leave
Dates Requested
Number of Hours
Supervisor Information
Direct Supervisor's Name *

First Name Last Name
Supervisor's Mid Email *
Requestor Information
Requestor's Email *
Requestor's Signature (Hidden)
Requestor's Signature *

Clear
I request the above leave time and certify that I have sufficient accumulated time to cover the request.

For Supervisors. Click button to respond to request.
Supervisor Response to Leave Request

Approved fully with no changes Denied fully (available for admin requests only) Approved with changes
Changes needed in order for request to be approved:
Supervisor Signature (Hidden)
Supervisor Signature

Clear
Mid Michigan College Payroll

Mid Michigan College Payroll
Should be Empty:

Leave Request Form