Leave Request

LEAVE REQUEST FORM

Students traveling outside of the Lufkin area overnight for a weekend leave must submit this form before 2pm on Friday or a $5.00 late fee will incur.
Students traveling outside of the Lufkin area overnight for a weekday leave must submit this form 24 hours before departure or a $5.00 late fee incur. If submitted after 5pm on Friday must have approval from the Resident Supervisor or Dean of Students.
An approved or denied response will be sent to the email provided.
If this leave request form is denied, corrections must be made and an updated leave request form must be submitted for approval.
Leaving campus before receiving an approved leave request form will result in a conduct violation in accordance with the student handbook p.30.
A weekday leave does not count against a student's allotted weekend leaves.
THIS FORM IS NOT FOR MINISTRY OPPORTUNITY OR WORK.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Your age *

** If under 21 and going somewhere other than home/residence, verbal parental permission from parent/guardian must be received through Dean of Student's office before approval **

Type of leave request: (check which is applicable) *

Weekday/s Weekend

Your destination *

Home/Residence Other (explain)

*Destination "Other" explanation *

Address *

Line 1

Line 2

City

State

Zip Code

Country

I will be staying with: *

Relationship *

*Relationship "Other" explanation *

Purpose of trip *

Time at home Time with friends Medical

Type of Transportation *

Owner of Vehicle *

First

Last

Traveling Companion(s) *

Departure Date *

MM / DD

Return Date *

MM / DD

Depart Time *

Include AM / PM

Return Time *

Include AM / PM

Submit

LEAVE ​REQUEST FORM

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LEAVE REQUEST FORM

Calendar