Choctaw County School System

CHOCTAW COUNTY SCHOOL SYSTEM

DETACHED DUTY AND RELEASED TIME REQUEST FORM

(Submit five (5) days prior to anticipated leave date)

NOTE: Complete both Part (A) and Part (B) for ALL leave requests. Attach a copy of agenda and/or meeting notice for ALL leave requests.

(Part A)

Date of Request: / Date of Leave
School: / Location
Purpose of Trip:

(Part B)

Approximate Time of Departure: / Date
Approximate Time of Return: / Date
Mode of Transportation: / Estimate Cost:
Estimated Lodging Cost (TOTAL): / Number of Nights:
Estimated Cost of Meals (TOTAL):
Other costs (Specify total and itemize):
Substitute: One-half (½) Day / Full Day
Total Estimated Cost:
Funding Source:
Account Code (Substitute):
Signature of Staff Member Making Request:
Trip Recommended By:
Principal or Supervisor
Approved:
Superintendent
Payroll Use
Code Sub:

Revised 11-07-05