One-Hour Permission Request Form
Submit your request for a one-hour leave of absence. Please provide all required details to ensure prompt processing.
Full Name
*
First Name
Last Name
Employee or Student ID
*
Department or Unit
*
Position or Role
*
Date of Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of One-Hour Leave
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Start Time of Leave
*
Hour Minutes
AM
PM
AM/PM Option
End Time of Leave
*
Hour Minutes
AM
PM
AM/PM Option
Reason for One-Hour Leave
*
Contact Phone Number During Absence
*
Please enter a valid phone number.
Format: (000) 000-0000.
Supervisor/Manager Name
*
Supervisor/Manager Email
*
example@example.com
Submit Request
Should be Empty: