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2. Time Off Request Policy

   Complete a Time-Off Request if you know you are going to miss more than 1 day of your scheduled service.  

   Please complete this form electronically at least 2 weeks in advance. Less than a 2 week notice does not guarantee approval. If the member is behind on hours the AmeriCorps Director may not approve the request.

   Members are expected to follow their Host Site's Time Off Request policy IN ADDITION to the program's policy.

   Approval of this time will not be completed until AmeriCorps Program Staff respond via email with the approval of this request.

4. Time Off Request Form
6. First Name*
7. Last Name*
9. Email:*
10. Today's Date*
    Today's Date
12. Date(s) Requesting Off*
13. Reason for Request*

    1. Vacation
    2. Bereavement
    3. Jury Duty
    4. Illness
    5. Other
14. If Other, please specify:
16. Has your site supervisor been notified?*

    1. Yes
    2. No
17. Site Supervisor Email*

    Please list your supervisor email here so that they can be contacted regarding this request prior to approval.

19. How many total hours will you miss as a result of this request?*
20. How many approved hours do you have at the time of this request?*
21. What is your plan to make up these hours?*
23. Electronic Signature*
    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.
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field