*
Required
This form must be submitted to your division office
at least 1 week in advance.
Prior Approval Received*
Yes, I have prior approval from my division head and have submitted a PTO request in ADP.
Today's Date
*
required
(mm/dd/yyyy)
First Name
*
required
Last Name
*
required
Class Subject
*
required
Grade Level
*
required
Name of Substitute Arranged
*
required
Total Coverage Hours Requested
*
required
Requested Coverage Day(s) / Time(s)
*
required
Requested Coverage Location(s)
*
required
Reason For Absence
*
required
Please send a confirmation email to the address below*: