September 24, 2020

Personal/Bereavement Day Request Form

(Complete this form and send directly to your administrator for reporting and approval).


  1.   Personal Day - At the discretion of the employee, three (3) days per year will be granted as personal days without loss of pay.  Except in the case of emergencies, notification to the employee’s immediate administrator or supervisor shall be made at least two (2) days in advance.  Personal days shall be for the purpose of attending to those needs not readily accomplished or able to be scheduled at other times.  Personal days may be used to attend family obligations and special events (e.g., weddings, class reunions, graduations, and religious holidays).  Personal leave may not be taken for such things as shopping trips or other recreational purposes, or to perform work for another organization.  No reason needs to be stated for said leave.  No personal days will be granted immediately before or after a vacation period, unless the Superintendent determines that extenuating circumstances warrant granting an exception to this rule.  Personal leave shall not be cumulative.

        A support-staff employee who has used both personal days may request to use emergency leave in the event of extenuating circumstances that require additional leave in a given year.  In accordance with the Negotiated Agreement, the use of emergency leave requires approval of the Superintendent or his/her designee.  At the end of each school year, unused personal days will be added to the number of accumulated sick days.
  2.   Emergency Leave- Three (3) days per year may be granted for emergencies (including bereavement and attendance at funerals) without loss of pay.  The Superintendent must approve payment for all emergency days taken.  Unused emergency days may be carried over and used under certain extenuating circumstances when deemed warranted by the Superintendent.  Requests for additional emergency days in any one year shall be made to the Superintendent or his/her designee.


Name_____________________________________Date Submitted_________________

Requested day:    _______Personal             _______Emergency

Date(s) Requested:_____________________________________________________________________

Reason for request of leave: _____________________________________________________________




Employee's Signature:_________________________________    Date:__________________________

Administrator's Action:       Approved___________________   Not approved___________________

Administrator's Signature:______________________________   Date:__________________________

Superintendent's Action if necessary:         Approved_____________    Not Approved___________________

Original : Supt.'s Office   2nd copy: Administrator  3rd copy: Employee

Link to Google Doc of Personal Day Form-Support Staff