HAMILTON COUNTY EDUCATIONAL SERVICE CENTER Revised 8/16/11        
  11083 Hamilton Avenue    
  Cincinnati, OH 45231  
  (513) 674-4200  
   
  (H/CCA EMPLOYEE)    
  Professional Leave Request  
  Submit (only one form) to Supervisor/Director.  
  This form will be returned to you.  
   
                                                                                Date Requested:  
Employee ID: <--Will Autofill Later  
Employee Name:  
Title of Meeting/Conference:  
Location:  
       Start Date:   End Date:  
   
NO RECEIPT TRAVEL    
NO LODGING    
REIMBURSEMENT MEALS   Comments for other:  
    OTHER    
   
TOTAL REQUESTED EXPENSES  
Directors Comments:  
Supervisor/Directors Approval is ON:  
TOTAL APPROVED EXPENSES  
___________________________________________________________________________________  
___________________________________________________________________________________  
                   
  REIMBURSEMENT REQUEST    
(To be completed after meeting/conference for reimbursement of expenses)  
ACTUAL EXPENSES INCURRED: Company Credit Card Expenses  
  TRANSPORTATION  Trans:  
NO RECEIPT MILEAGE per mile Lodging:  
NO LODGING  Meals:  
REIMBURSEMENT MEALS (per policy)*  Other:  
  REGISTRATION    
  OTHER:    
   
TOTAL OUT OF POCKET EXPENSES BEING CLAIMED FOR REIMBURSEMENT  
   
Comments:  
Approval for Reimbursement is On Amount  
*15% Maximum tip on meals     Invoice# PO#