Staff Leave Form

Employee Name (Required)

Employee E-Mail Address (Required)

Department Approval (Required)

Select Recipient of Form for Approval

<pncurt01@louisville.edu>
<laeric02@louisville.edu>
<zeda.frazier@louisville.edu>
<mjmard01@louisville.edu>
<famian01@louisville.edu>
<tpmoor01@louisville.edu>
<clpatu01@louisville.edu>
<kjpend01@louisville.edu>
<n0pett01@louisville.edu>
<d0rams01@louisville.edu>
<sdstat01@louisville.edu>

Type of Leave Requested (Required)

Annual/Vacation
Bereavement
Jury Duty
Military
Parental
Personal
Sick
Voting
Other

Comments

Date and Time Requesting Leave to Begin (Required)

/ /

:

Date and Time Requesting Leave to End (Required)

/ /

:

Is Family and Medical Leave Appropriate or Required

Yes
No

Departmental Approval List

Pamela Curtis - pncurt01@louisville.edu>
Leslye A Erickson -laeric02@louisville.edu
Suzanne Galbreath - zeda.frazier@louisville.edu
James M Mardis -mjmard01@louisville.edu
Frank Mianzo - famian01@louisville.edu
Timothy P Moore - tpmoor01@louisville.edu
Cathy Patus - clpatu01@louisville.edu
Kathy J Pendleton -kjpend01@louisville.edu
Nadine Petty - n0pett01@louisville.edu
Dale R Ramsay - d0rams01@louisville.edu
Shannon D Staten - sdstat01@louisville.edu

Departmental Approval List

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