30 days notice is required for time off requests. We will do our best to honor time-off requests based on availability. Requests are granted on a first come, first serve basis.

    List a TEAMMate that will be covering your group (therapist) or hours/core job duties (admin) :

    Date

    Date

    Date

    Date

    Date

    Please list alternate hours you would like to work instead of using your PTO time

    Please provide the reason for PTO request: