STEP AmeriCorps Time Off Request

Time Off Request
You can use this form to request partial days off, whole days off, and consecutive multiple days off. Please use separate forms for each request.
Name*
Email*
example@example.com
Service Site*
Start Date Requested Off*

MonthDayYear
Date
Are you requesting time off for consecutive whole days?*

YesNo
End Date Requested Off*

MonthDayYear
Date
Start time requested off*

Hour Minutes

AM/PM Option
End time requested off*

Hour Minutes

AM/PM Option
Reason for Request*

VacationBereavementSchool activity (if currently a student)Medical/dental appointmentOther
Flex days do not need to be made up, but it is still the member’s responsibility to keep track of hours and assure that you are on track to complete your hours on time. If you are not requesting a flex day, then you will need to add a plan for making up the hours missed.
Are you requesting a flex day?*

YesNo
What is your plan to make up the requested hours off?*
How many approved service hours do you have as of the time of this request?*
By signing below, I certify that I understand that the time that I request off does not count towards my contracted hours and that I will need to make up all missed hours.*
Should be Empty: