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Application For Excuse of Absence Without Pay And/Or As Non-Attendance

Last Name *

First Name *

Department *

Email Address *

Phone *

Which Date Would You Like to Request * +

Reason for Non-Attendance Request *

Other Less Common Reasons For Non-Attendance *

What is the Reason For Your Non-Attendance Day *

Is There a 2nd Date You're Requesting? *

Yes

No

2nd Date You'd Like to Request * +

Reason for Non-Attendance Day 2 *

Other Less Common Reasons For Non-Attendance Day 2 *

What is the Reason For Your Non-Attendance Day 2 *

Is There a 3rd Date You're Requesting? *

Yes

No

3rd Date You'd Like to Request * +

Reason for Non-Attendance Request Day 3 *

Other Less Common Reasons For Non-Attendance Day 3 *

What is the Reason For Your Non-Attendance Day 3 *

Is There a 4th Date You're Requesting? *

Yes

No

4th Date You'd Like to Request * +

Reason for Non-Attendance Request Day 4 *

Other Less Common Reasons For Non-Attendance Day 4 *

What is the Reason For Your Non-Attendance Day 4 *

Is There a 5th Date You're Requesting? *

Yes

No

5th Date You'd Like to Request * +

Reason for Non-Attendance Request Day 5 *

Other Less Common Reasons For Non-Attendance Day 5 *

What is the Reason For Your Non-Attendance Day 5 *

Is There a 6th Date You're Requesting? *

Yes

No

6th Date You'd Like to Request * +

Reason for Non-Attendance Request Day 6 *

Other Less Common Reasons For Non-Attendance Day 6 *

What is the Reason For Your Non-Attendance Day 6 *

Is There a 7th Date You're Requesting? *

Yes

No

7th Date You'd Like to Request * +

Reason for Non-Attendance Request Day 7 *

Other Less Common Reasons For Non-Attendance Day 7 *

What is the Reason For Your Non-Attendance Day 7 *

Is There a 8th Date You're Requesting? *

Yes

No

8th Date You'd Like to Request * +

Reason for Non-Attendance Request Day 8 *

Other Less Common Reasons For Non-Attendance Day 8 *

What is the Reason For Your Non-Attendance Day 8 *

Is There a 9th Date You're Requesting? *

Yes

No

9th Date You'd Like to Request * +

Reason for Non-Attendance Request Day 9 *

Other Less Common Reasons For Non-Attendance Day 9 *

What is the Reason For Your Non-Attendance Day 9 *

Is There a 10th Date You're Requesting? *

Yes

No

10th Date You'd Like to Request * +

Reason for Non-Attendance Request Day 10 *

Other Less Common Reasons For Non-Attendance Day 10 *

What is the Reason For Your Non-Attendance Day 10 *

If you need to submit more days please start another form when you're finished. Thank you!

Special Rules Governing Non-Attendance

Appearance for Jury Duty: Board of Education must be paid compensation received for jury duty.

Special Rules Governing Non-Attendance

Appearance for Jury Qualification: Up to 3 hours but only when notice requires appearance during school
hours. Substitute not authorized. Time to be arranged with principal in advance.

Special Rules Governing Non-Attendance

Appearance as Disinterested Witness: Before court, public board, commission or officer in case where
neither employee nor anyone related to the employee in any way has a financial or personal interest either
directly or indirectly and where the employee’s attendance is not required as a result of any employment,
occupation or voluntary act by the employee.

Special Rules Governing Non-Attendance

Death in Immediate Family or Household: Day of death and up to 3 calendar days immediately following death of parent, child, brother, sister, grandparent, grandchild, spouse, parent of spouse or any relative or steprelative residing in staff member’s personal household. Time required exceeding this allowance (e.g., travel to
funeral at a remote place) requires application on Form OP 201 and approval by responsible superintendent.

Death of Relative Outside Immediate Family or Household: Up to 1 day for funeral of brother-in-law,
sister-in-law, son-in-law, daughter-in-law, nephew, niece, uncle or aunt not residing in employee’s personal
household.

Special Rules Governing Non-Attendance

Funeral of an Associate: Up to 1 day for funeral.

Special Rules Governing Non-Attendance

Degree or Graduation: Day of exercises marking award of diploma or degree by recognized school or
institution of higher learning to employee, employee’s parent, spouse, child or step-child. Excluded are
ceremonies, however designated, such as “graduation” from nursery school or kindergarten or related to
incidental or supplementary instruction such as released time. Up to 2 additional days so as not to exceed 3
consecutive calendar days when necessary to attend exercises at a remote place require application on Form OP
201 and approval by the responsible superintendent.

Special Rules Governing Non-Attendance

Extraordinary Transportation Delay: Up to 3 hours by the principal. Additional time up to 2 consecutive
school days requires application on Form OP 201 and approval by the responsible superintendent except when
covered by a blanket directive.

Special Rules Governing Non-Attendance

Legislative Hearing: Only with express permission obtained in advance from the Community Superintendent
(or, for City District staff, from the Office of Personnel acting for the Chancellor) may any employee testify
before a legislative hearing or similar inquiry concerning school matters. Requires application on Form OP 201
and approval by the Community Superintendent (or, for City District staff, by the responsible Assistant
Superintendent).

Special Rules Governing Non-Attendance

Ordered Military Duty: Up to 30 calendar days in each school year for reserve duty of regularly appointed
personnel; for regular substitute ordered to reserve duty during fall term, may not exceed period through
January 31 or, when ordered to duty during the spring term, may not exceed period through close of school in
June (since regular substitutes are considered employed by the term only). Time required for selective service
examination (but not for entry into service other than as reservist) is granted as non-attendance.

Special Rules Governing Non-Attendance

Quarantine: For inclusive period shown on quarantine certificate.

Special Rules Governing Non-Attendance

Religious Observance: Subject to deduction approximating one day’s pay for each day granted.

Special Rules Governing Non-Attendance

Requirement of the School System: As officially ordered to meet a requirement of the Community District,
City Board of Education or Board of Examiners (whether as an assistant or candidate).

Special Rules Governing Non-Attendance

School Visits and Meetings Within New York City: Substitutes engaged only within U.F.T. agreement limit
of an average of four teachers per school year in each school and not to cover supervisors covered by C.S.A.
agreement which limits supervisors to four day per school year.

Special Rules Governing Non-Attendance

Appearance on Official Business: Before court, public board, commission or officer on business of
Community Board or City Board of Education.

Who's Your AP

Franzese, Richard

Jacobs, Suzane

Kornaker, Jenessa

Kraszewski, Kamil

Lazo, Patricia

Nunez, Christine

Odita, Anthony

Peterson, Albert

Pinsky, Max

Quinlan, Robert

Rosenfeld, Tovia

Simon-Jack, Sakaina

Stack, Alan

Vershleiser, Beth

Other

Does your AP approve this request? *

Yes

No

Important!

Your request will likely be denied if your AP is unaware or hasn't approved this form submisson.

Comment or Explanation:
Give name and relationship of persons ill or deceased, graduating or receiving degree, nature of subpoena or notice or other directive requiring appearance, name of schools or activities visited, sponsoring organization, date and place of meeting or convention, or extent and type of military duty. Copies of orders, directives, notices, subpoenas or like evidence should be attached as Supporting Documentation.

Supporting Documentation

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