Leave Request for (Exempt) Faculty and Staff

See instructions for questions about completing this form.

PERSONAL INFORMATION First and Last Name (required): Email Address (required):

DATES/HOURS OF LEAVE

Vacation and Sick Leave are recorded in 4 hour increments

From Date: From Time: To Date: To Time: Total Hours Requested:

LEAVE TYPE

Choose One:

Vacation Leave VAE | Hours and Dates:

Sick Leave SCE | Hours and Dates:

Parental Leave PLE | Hours and Dates:

Funeral Leave FNE | Hours and Dates:

Jury Duty JRE | Hours and Dates:

Military Leave MIE | Hours and Dates:

Leave Without Pay LWP | Hours and Dates:

Discretionary Day DDE Date:

Holiday Compensatory Time HCE | Hours and Dates:

Other Absence | Type, Hours and Dates:

*Other Leave: Disaster Leave-DIS, Donor Leave-DON, etc.

REASON Reason for Leave / Other Absence

SUPERVISOR Supervisor's Email (Required)

DEPARTMENT TIMEKEEPER Timekeeper's Email (Required)

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Signatures only required if printing request instead of submitting online.

Employee's Signature: Date: Supervisor's Signature: Date:

KSU Policy and Procedures Manual Chapter:

Related Information: