1. EMPLOYEE REQUEST FOR EDUCATIONAL LEAVE TO ATTEND CLASS
    2. Approvals:

September 4, 2001   BA-1412.2C
 
 
 
 
 

 
**Submit this form to Supervisor at least 15 days prior to the 1st 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)

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