CLINTON PUBLIC SCHOOLS

Request For Professional Leave Form

(A minimum of 48 hours advance notice is required.)

 Name:                                                ¨ Joel  ¨ Pierson  ¨ Eliot  ¨ Morgan     Grades/Subject:                           

I feel that my attendance at the meeting described below will aid both my performance in my assignment and the
 school system and, therefore, request permission to attend.

Title of Session:                                                                                                                                                 

Group(s) Sponsoring Session:                                                                                                                            

Date(s) of Session:                                                     Location (town):                                                            

Reason I believe this session will be a benefit to the school system and me:                                                                

INFORMATION GAINED WILL BE SHARED IN THE FOLLOWING WAY(S):

          ¨   Faculty Meeting                    ¨   Team Meeting                       ¨   Handouts to Staff

            ¨   In-Service Program               ¨   Department Meeting               ¨   Special Areas/Sp. Srvs. Mtg

            ¨   Other (explain):                                                                                                                                   

IN ORDER FOR ME TO ATTEND:

            ¨   No Substitute Needed                   ¨   Substitute Needed – Date(s)                                                          

¨   No Expenses Involved                  ¨   Expenses Itemized on the Attached Sheet:  $                                   

                                                   ^_                                                                                                                      

Signature (Employee)                                                                                   Date

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DO NOT WRITE BELOW THIS LINE.  FOR ADMINISTRATIVE USE ONLY.

Source of Funding:

          ¨ School/Cost Center Budget           ¨   District-Wide Budget                       ¨  N/A

          ¨   Grant (specify)                                                                                                                                    

          ¨   Other (specify)                                                                                                                                    

Signature (Administrator)                                                                                     Date     

Assistant Superintendent’s Action:

          ¨  APPROVED            ¨  DENIED -  REASON: 

Signature (Assistant Superintendent)                                                                    Date

Approved by CCPD (TAPP) Committee 12/06/01 Rev. 1/05