Date of Request _________________________________

Employee Name ____________________________________________________

School _______________________________________________

Vacation Days Available _______________________________________

                                                    (To be filled in by district)  

Vacation Days Requested _____________________________________________

Dates ___________________________________________________

Substitutes Name ______________________________________________

                                (if vacation is taken while school is in session)

Employee Signature _____________________________________________________

Principals Approval ___________________________________    Date ________________

Superintendents Approval ______________________________    Date ________________

*Request must be submitted 2 weeks ahead of time.

*Vacation days must be used between July 1 to July 1 (fiscal year). It is recommended that vacation time be used during the summer months unless the employee has received special approval.

Days cannot be carried over into the next fiscal year.