POLK COUNTY PUBLIC SCHOOLS LEAVE OF ABSENCE REQUEST FORM 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields, including your name, SAP number, address, and telephone number.
3. Indicate the beginning date of your leave and anticipated return date. Be sure to provide accurate dates to avoid any processing delays.
4. Select the type of leave you are requesting by circling the appropriate reason for leave. If applicable, attach any required documentation such as court orders or medical certifications.
5. In the section regarding accumulated leave, specify how much sick or vacation pay you will be using during your absence. Clearly indicate if it is all, none, or partial.
6. Review all sections carefully to ensure completeness and accuracy before signing and dating the form at the bottom.
7. Submit your completed form via mail or fax as instructed. Ensure that you do not email the form.

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