MADISON AREA EDUCATIONAL SPECIAL SERVICES UNIT
STAFF ABSENCE REPORT

PART I.	TO BE COMPLETED BY EMPLOYEE

Employee: ______________________________________          Date: _____________________

I request approval for being absent from work on the following date(s):
_____________________________________________________________________________	

This absence is for:	
	Leave Time (Certified Staff Only)
If leave time is immediately before or after  a school break/recess, indicate the reason below.		Death Leave (relationship of relative): ____________________________
____________________________
	
	Sick Leave

		Vacation	
	Personal Business (transaction of personal business and/or the conduct of personal or civic affairs which cannot be scheduled outside of regular school hours) Note: The third day cannot be used to extend a vacation.		Professional Leave (check one)
____ Case Conference/ACR
____ In-Service (co-op area)
____ In-Service/Meeting (outside  co-op)	
	Family Illness Leave 
State family member/relationship:
 
_______________________________

		Other (i.e. Jury Duty, Temporary Disability, etc.) Specify ____________
________________________________
________________________________	

 	__________________________________________________________________
Employee Signature

PART II.	TO BE COMPLETED BY EMPLOYER

Date Received:  __________________________________		   Approved

									   Denied

________________________________________________	     _____________________
Supervisor							              Date

Comments: ____________________________________________________________________

j/ssuforms/central forms/absence slip