Kaw Valley Unified School District #321
411 W. Lasley St. Marys, KS 66536 / Phone: 785.437.2254 TEACHER PROFESSIONAL LEAVE REQUESTInstructions: Complete form, print, and sign; turn in five days prior to request.
TO: Ms. Jane DavisMrs. Ann McCulloughMr. Toby McCulloughMr. Bill RussellMr. Eric Steele & Mr. James McDaniel, Building Leader & Superintendent
FROM: (Teacher's Name)
This is a request to take Professional leave on (or beginning):
If other please specify:
Month: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay: Year: 2012 2013 2014
Please state reason for Professional Leave:
Please Select One:
All DayA.M. OnlyP.M. OnlyMultiple Days
If leave is multiple days, please indicate the number of days requested:
Teacher's Signature _____________________________________________________
Building Principal
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