Employee Name:    EmployeeID(emplid#):
Employee Title:
Employee Department:
Employee Email Address:
please enter the complete email address (ie user@louisville.edu)

Type of Leave Requested: (Choose One): Annual Sick Bereavement Jury Duty Other *

Explanation:

Total Number of Hours (Optional):

Please enter the EMAIL ADDRESS of your supervisor or the appropriate person for approval of your leave requests: