I would like to request approval to take _________________#____________ during the

    _______________ semester on __________________ from _______to________.
                                                                            (day/s of the week)                            (hours of course)

Describe your educational plan, including why it is in the University's best interest to allow you to take a course during regularly scheduled hours of work.
 
 
 
 
 
 
 
 
 
 

Check all that apply.

                   _____I will use annual leave to take this course.

In order for the work schedule to be altered, the following points must apply.

                   _____The course is not offered at a time outside normal working hours.

                   _____The course does not exceed five contact hours per week.

Proposed work schedule alteration. Please list days, showing hours to be worked and hours attending class. Remember to allow time for travel to and from class.
 
 
 
 
 
 
 
 
 
 

Approved:

I recommend approval of this request for an alternate work schedule. This course will not interfere with the employee's work obligations.
 
 

_________________________ _______________
Unit Supervisor                                  Date