Lumpkin College Student Hub Absence Request Form

Please complete this form each time an absence from duty occurs.

Name Name * First Last
Email *
Month of Requested Leave: *

Month of Requested Leave: January February March April May June July August September October November December

Only one month per request form.
Date(s) of requested leave: *
Amount of Time Absent (hours) *

Enter the number of hours you will be absent during normal work hours.
Working Through Lunch to Make Up Time (Same Day Only) *

Working Through Lunch to Make Up Time (Same Day Only) Yes - I am working through lunch. No - I am not working through lunch.
Amount of Leave Used (hours) *

Enter the number of hours you will use of leave.

If you are working through your lunch, this number will not match the Amount of Time Absent.
Type of Leave *

Type of Leave Sick Leave Accrued Leave Personal Day (ASP only) Other - explain in comment box
Additional Information (Optional):