Form

REQUEST TO LEAVE EARLY FORM
		Date of Request:
To:	Kim W. Cox, Principal
From:
Subject:	Request to leave early

I am requesting permission to leave the worksite at		(Time):	on (Date):

The reason for this request is:


	*24 hour notice is required on all requests. Emergencies will be handled accordingly.

Coverage for my classes will be provided by:		Signature of person providing coverage:
		Signature of person providing coverage:

Approved		Signature of approving administrator
Denied		Signature of disapproving administrator

Cc: Employee Principal

Carol City Middle - 3737 NW 188th Street - Miami Gardens, FL 33055 - Kim W. Cox, Principal 305-624-2652 - 305-627-7066 (fax) - kwcox13@dadeschools.net