EMPLOYEE REQUEST FOR EDUCATIONAL LEAVE TO ATTEND CLASS
Approvals:

September 4, 2001 BA-1412.2C

**Submit this form to Supervisor at least 15 days prior to the 1^st day of the requested semester/session.**

EMPLOYEE REQUEST FOR EDUCATIONAL LEAVE TO ATTEND CLASS

Name of Employee Campus/Division Employee ID

Semester/Year Campus/Site

Name of Institution:

Check one: Delgado Community College

Other (Specify) ____________________________________

Name(s) and Prefix(es) of Course(s):

Number of Credit Hours*:

*Note: Educational Leave may be granted for a maximum of three (3) clock hours to attend class for the approved course of study.

Day and Hours of Class:

Explain how this course relates to your present position:



Signature of Employee
	Date

Approvals:



Signature of Immediate Supervisor
	Date



Signature of Intermediate Supervisor (if applicable)
Date




Signature of Executive Dean/Vice Chancellor
	Date

Form 1412/001 (5/16)