Kaw Valley Unified School District #321

P.O. Box 160 -- St. Marys, KS 66536 / Phone: 785-437-2254

Request To Borrow Leave From Sick Leave Bank
Instructions:  Complete form, print, and sign.

 

 

Name of Member: 
  
Number of Days Eligible:
  
Number of Days Requested:
  
Reason for Requesting Leave:

  

This form must be submitted to the District Office.

 

PLEASE DO NOT WRITE BELOW THIS LINE

 

Date Request received by District Office   _________________________________

 

This request has been reviewed by the Sick Leave Bank Committee and has been:

 

__________

Approved
  

__________

Denied

 

If denied, state reason: ________________________________________________