Lincoln County School District No.

2
Professional Leave Request Form
Use your cursor to click through and complete the form. Send it electronically to your administrator. Your administrator will approve it
and send it to the District Office. A signed copy will be returned to you upon District approval. Incomplete forms will be returned.

Name: School: Dates of Leave:

Conference/Training Title: Conference Location:

Duration of Conference/Training: hours; or days

Which of these objectives/indicators does this professional leave request address? Check ALL that apply.

1.1 This professional development activity is directly related to improved classroom instruction.

2.1 This professional development activity is aligned to both content and performance standards.

3.1 This professional development activity is an intensive and sustained effort.

4.1 This professional development activity is for staff who work with disadvantaged populations (i.e. Title I,
Special Education, At-Risk Youth, etc.).

5.1 This professional development activity provides training related directly to the school improvement
goals (i.e.: reading, writing, math) appropriate to my attendance center.

6.1 This professional development activity provides training directly related to my personal professional
development goals.

7.1 This professional development activity provides training related to technology integration.

8.1 This professional development activity is directly related to standards-based teaching and/or
performance-based assessment.

Estimated Cost: Amount Approved

Meals Funding Source must be checked by principal
Lodging Title I
Transportation Title II
Airfare Title IV
Registration Title VI-B
Other General Fund/District
TOTAL Attendance Center

Expenses may be approved in part or entirely. I understand that the purpose of professional meetings is to improve the service to the children in Lincoln
County School District #2. I also understand that payment for approved expenses will not be made until receipts and vouchers have been submitted.
My name on the following appropriate line constitutes agreement to the above referenced training and associated costs.

Employee: Date:

Administrator: Date:

District Signature: Date:

Substitute Needed: Yes No

Sub Helpdesk Contacted: Yes No
Requested Sub: