Leave Request Form

Academic Affairs

Leave Request Form

12-Month Employees

Academic Affairs Leave Request Form

  • Drop files here or
  • Please select the date for the pay period ending in which you are reporting leave time. This will be the 15th or last day of the month.



All 12-month employees (administrators, non-classified staff, and classified staff) must complete this form for each type of leave.  A copy of the completed form will be retained by the Office of Student Success.  Leave requests and leave taken are subject to audit.