ProMatch - Leave of Absence Form

ProMatch Leave of Absence Form

If you need to be absent from ProMatch for more than one week for any reason other than a return to work (which includes temporary, contract, or survival work), please complete this form. This form tells staff to stop the clock on your time at ProMatch, so that service hours are not deducted. Members can take up to 60 days of leave total.

If you need to leave ProMatch due to work (including temporary, contract, or survival work), please complete the ProMatch "Return to Work" form.

Please fill out, print, sign, and give the following form to ProMatch staff. You can also fax or mail your completed form - contact information is listed at the bottom of this page. You will not be able to email this web site form to staff, as the information that you enter in this form will not save.

Reason for Leave of Absence:

School Vacation NOVA Workshop Other (Please specify below)

Start date for your Leave of Absence

Estimated Length of Absence
(Note: Please complete a ProMatch "Request to Re-Activate" form when you return to ProMatch, as the form notifies ProMatch staff to re-activate your ProMatch membership.)

Name:

Telephone:

Email Address:

REMEMBER: Please print this form before leaving this page or closing the browser window, otherwise you will lose any information you entered.

Your Signature: ______________________________ Today's Date: