LEHMAN COLLEGE LEAVE REQUEST FORM DATE: ___________ EMPLOYEE: _____________________________ TITLE: __________________________ DEPARTMENT: __________________________ EXTENSION: ____________________ TYPE OF LEAVE AND DATES REQUESTED: ANNUAL LEAVE: *Start Date: ___________ **End Date: ___________ SICK LEAVE: *Start Date: ___________ **End Date: ___________ UNSCHEDULED HOLIDAY: *Start Date: ___________ **End Date: ___________ COMPENSATORY TIME: *Start Date: ___________ **End Date: ___________ TOTAL NUMBER OF DAYS: ________________ EMPLOYEE SIGNATURE: _______________________________ APPROVED PLEASE SEE ME SIGNATURE: _____________________________________ *START DATE includes the first day of your leave **END DATE includes the last day of your leave