To: Hawkins County Board of Education

I hereby request _______________ leave beginning ___________

(Type of Leave) (Date)

and will return to work on ___________ as a ________________ at

(Date) (Position)

___________________________________.

(School)

While I am on Leave, If I am due a payroll check for any reason, (please circle one):

Mail my Check to my house. Send my check to the school

______________________________________ ____________________

(Signature) (Date Submitted

Text Box: For Central Office Use Only

Approved by:___________________________ Date:_________________
(Director of Schools)