WSSU Request for Leave

Email Secondary Email

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Email address *

First name *

Last name *

Type of leave requested: *

Sick Vacation Comp Other

Beginning Date: *

Beginning Time: *

Ending Date: *

Ending Time: *

Total # of Work Hours Requested: *

Remarks or Explanation: *

EMPLOYEE’S CERTIFICATION FOR SICK LEAVE ONLY

I certify that I was sick and unable to attend my official duties during the period for sick leave as made above, or there was a death in my immediate family.

Signature for Sick Leave:

This request for leave will be forwarded to your supervisor for final approval.

* required field

Winston-Salem State

Graduating Champions

We See Red

WSSU Request for Leave