Media Investigative Leave of Absence Request
Submit this form to request a leave of absence for investigative reporting or media assignments.
Applicant's Full Name
*
First Name
Last Name
Applicant's Email Address
*
example@example.com
Applicant's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department/Team
*
Please Select
News
Editorial
Broadcast
Digital Media
Photography
Other
Position/Title
*
Start Date of Leave
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Date of Leave
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purpose of Investigative Leave
*
Location(s) of Investigation
*
Supervisor's Name
*
Supervisor's Email Address
*
example@example.com
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant's Signature
*
Submit Leave Request
Submit Leave Request
Should be Empty: