Professional Leave Request Form

Professional Leave Request - Location
At an MCCSC building or specified in-district locationAt a location outside of an MCCSC building or specified in-district location

Trip Information

Page 1
Hourly Support StaffSalaried Support StaffCertified Staff (ex: Teachers, Counselors)Building Level Administrative StaffDistrict Level Administrative StaffSchool Board Member

Rows	Conference Registration Fees	Travel Costs	Other Costs
Estimated Trip Expenditures

Total Estimated Professional Leave Costs:
This will automatically calculate from the fields entered above.
Departure Date*

MonthDayYear
Date
Today's Date

MonthDayYear
Date
Calculation
Return Date*

MonthDayYear
Date

Professional Leave Request - Advance Notice
Requests for Professional Leaves should occur with 30-day advanced notice. If an exception is required due to mandatory training, please contact Janet Schreiner in the office of Curriculum & Instruction (jschrein@mccsc.edu).
Yes
Please provide your name and email address below:
Email*
example@mccsc.edu
Name*

First NameLast Name

Professional Leave Request - No Approval Necessary
This professional leave request does not require approval. Please submit your expenditures for reimbursement, if any, when returning from your professional leave event.

Professional Leave Reimbursement Form(link)
Yes

Professional Leave Request - Approval Necessary

Page 2
This professional leave request requires supervisor approval.

Please answer each of the following prompts below to assist with supervisor review.
Are you filling this form out on behalf of another individual or individuals?*
Is this request a submission in bulk for multiple individuals?*
Please submit the information below for the individual attending.
Name*

First NameLast Name
TypeUpload
Upload - Individuals attending

Please provide names and e-mails on this list.
Cancelof
Manual Entry - Individuals attending
Please provide names and e-mails on this list.
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@mccsc.edu
Primary Building Assignment*
Code:
Supervisor E-mail
example@mccsc.edu
Admin Asst E-mail
example@mccsc.edu
Student Services (Supervisor - Becky Rose)Special Education (Supervisor - Blain Garman McClaine)Early Learning (Supervisor - Laura Stickles)N/A
Departmental Email
example@example.com
Departmental Email 2
example@example.com
Departmental Email (admin asst)
example@example.com

Professional Leave Request - Policy Acknowledgement

Page 4
Yes
Name of person completing this form:*

First NameLast Name
Email of person completing this form:*
example@mccsc.edu
Primary building assignment of person completing this form: *
Signing below indicates all expenditure estimates and trip information listed are accurate to your knowledge and that you have reviewed all applicable MCCSC travel policies.
Signature*

Clear
Should be Empty:

Professional Leave Request - Location