Page 4 - Flipbook test Policy & Procedure_Neat

EMORY UNIVERSITY
Office of the Registrar
Education Request Form

EMPLOYEE NAME:_______________________________________________________________

SCHOOL NAME:_________________________________________________________________

SEMESTER: _______________________________ DEGREE SEEKING: Yes_____ No_____

BEGIN DATE: ________________________ END DATE: ________________________________

PROPOSED WORK SCHEDULE (must equal 40 hours per week, between the hours of 7:00–4:30)

Work Schedule
Work Hours Class Time Work Hours Total Hours Earned
Monday
Tuesday
Wednesday
Thursday
Friday
Educ. Leave 2
Vacation Leave
Total Hours 40

EXAMPLE
Work Hours Class Time Work Hours Total Hours Earned
Monday 8:00 – 2:30 2:30 – 4:30 6
Tuesday 8:00 – 4:30 8
Wednesday 8:00 – 12:30 12:30 – 2:00 2:00 – 4:30 7
Thursday 7:30 – 4:30 8.5
Friday 8:00 – 4:30 8.0
Educ. Leave 2
Vacation Leave .5
Total Hours 40

Employee Signature: _________________________________________Date: ______________

( ) Approved ( ) Disapproved

Reason for Disapproval: __________________________________________________________

Supervisor Signature: ________________________________________Date: ______________

May 30, 2013  Page 4