Vacation / Time Off Request

Please fill out all fields to the best of your ability.

First Name *

Last Name *

Email Address *

Full Day Request

For a partial day request, please complete section below

Leave Date +

Return Date +

Total Hours Requested

Partial Day Request

For a full day request, please complete section above

Date +

Time Out From:

Time Out To:

Total Hours Requested

Reason for Leave

To receive a copy of this form, please enter your email address below:

Sick	Vacation	Jury Duty
Bereavement	Ministry	Training/Conference