Emergency Leave Form

Each VISTA is allotted 5 emergency leave days. Emergency Leave must fall into the following category: “immediate family member (spouse, parent, sibling, child, grandparent, or guardian) becomes critically ill or dies." Emergency days must be approved by the Program Sponsor, so please submit this form at least 24 hours in advance. Emergency Leave will not count against Personal Leave. If additional days are needed, the request has to be approved by the CNCS State Program Director. If you have any questions, please contact your VISTA Leader.

* Indicates required field

Name *

First

Last

Please provide the dates you expect to be out of the office. *

Please provide the details of the circumstances for which you are requesting Emergency Leave. *

My site supervisor has already been made aware of my absence on these days. *

Yes No

Submit