1. Request for Leave of Absence and Advance Degree Leave
    1. Delgado Community College
    2. LCTCS Form - Request for Leave of Absence and Advanced Degree Leave
    3. Page 2
    4. Approvals:
    5. ______________  ________________________________________________________
    6. _______________  ________________________________________________________

 

Request for Leave of Absence and Advance Degree Leave

 

 

Institution: Delgado Community College Date: __________________________

 

Name of Employee: _________________________ Social Security No. _________________

Title: ______________________________________________________

Department: _______________________________

Highest Degree: _____________________ Birthday: Month____ Day____ Year ___ Age: ___

 

Number of Consecutive Fiscal Years Active Service with current employer: __________________________________________________________________________

 

Purpose of Leave Requested (Check one):

a. Advance Degree ______

b. Leave of Absence ______ _

 

Manner in which this leave, if granted, will be spent: (Also include information as to how the degree will benefit the work you perform for the College.)

______________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________

 

Effective Dates of Leave: Beginning __________________Ending ______________________

 

 

I have reviewed the RULES (Bylaws and Policies and Procedures) of the Louisiana Community and Technical College System, Policy # II.3.003, pertaining to Advances Degree Leave and Leaves of Absence and hereby agree to comply with the provisions enumerated therein.

________________________________________

Signature of Applicant

 

Prior Leave Record From this Institution (To be certified by the institution):

 

Date of Last Leave: _____________________ Length of Last Leave: _____________________

 

Type of Last Leave: With Pay __________ Amount $ ___________ Without Pay ____________

 

Type of Leave Recommended by Supervisor (Check One)

 

a. With Pay ______ % of Salary _____ Amount $_________

 

b. Without Pay ______

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Delgado Community College


LCTCS Form - Request for Leave of Absence and Advanced Degree Leave


Page 2

 


Approvals:

 

Note: Employee is responsible for submitting a signed Recommendation Letter from his/her Department Manager/Supervisor with this application to the Human Resources Department. This form will not be considered for approval without this documentation.

 

The supervisor is responsible for obtaining the signature of the Assistant Vice Chancellor for Financial Services of budgetary availability of funds for any instance where leave is recommended to be with pay.

 

 

______________   ________________________________________________________

Date Approved   Signature of Employee’s Department Manager/Supervisor  

 


______________   ________________________________________________________

Date Approved   Signature of appropriate Vice Chancellor

          

______________   ________________________________________________________

Date Approved   Signature of Assistant Vice Chancellor for Financial Services

 

_______________   ________________________________________________________

Date Approved Signature of Assistant Vice Chancellor for Human Resources

 


_______________   ________________________________________________________

Date Approved Appointing Authority for LCTCS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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