Vacation Request Form

Employee Information

Full Name *

Banner ID *

Employee Email *

Phone Ext. *

ORG *

Enter 4 digit dept. # above.

Immediate Supervisor Approval

Enter the email address for the supervisor who approves your vacation requests in the space provided below:

Supervisor Email *

Paid Time Off Request Details

To streamline the processing of this form by the Human Resources Department, please limit the start and end dates provided on a single Vacation Request form to dates which fall within the same month. However, you may include end dates that cross over into another month.

For example, if you are taking the whole week of 6/29 off, you may include all dates in that week on a single request including those which fall within the month of July.

Row 1

1 Start *

Month

Day

Year

1 End *

Month

Day

Year

1_Total Hours *

1 Total Minutes *

Round to nearest 1/4 hr

1 Total {hh1}+{mm1}/60

Add Another Row?

Yes

Row 2

2 Start *

Month

Day

Year

2 End *

Month

Day

Year

2 Total Hours *

2 Total Minutes *

Round to nearest 1/4 hr

2 Total {hh2}+{mm2}/60

Add Another Row?

Yes

Row 3

3 Start *

Month

Day

Year

3 End *

Month

Day

Year

3 Total Hours *

3 Total Minutes *

Round to nearest 1/4 hr

3 Total {hh3}+{mm3}/60

Add Another Row?

Yes

Row 4

4 Start *

Month

Day

Year

4 End *

Month

Day

Year

4 Total Hours *

4 Total Minutes *

Round to nearest 1/4 hr

4 Total {hh4}+{mm4}/60

Employee Comments

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Vacation Request Form

To streamline the processing of this form by the Human Resources Department, please limit the start and end dates provided on a single Vacation Request form to dates which fall within the same month. However, you may include end dates that cross over into another month.