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 |  |  |  |  |  |  | City and County of Denver
 |  |  |  |  |  |  | Parental Involvement Leave Request
 |  |  |  | Instructions
 |  |  |  |  |  | An employee shall provide the Office of Human Resources with notice of the need for Parental Involvement Leave at least seven calendar days in advanced of an academic activity (see activity types in Activity Information section). Such notice shall include written verification from the school or school district of the academic activity prior to use.
 |  |  |  |  |  | In case of an emergency where the employee is not aware of the need for leave seven calendar days in advance, the employee shall provide the Office of Human Resources with notice of the leave as soon as possible after becoming aware of the academic activity. Written verification shall be provided upon the employee's return to work the shift following the parental leave. If there is no documentation submitted, the leave will be reversed off the employee's timecard.
 |  |  |  |  |  | For assistance filling out this form or for questions regarding your eligibility to use Parental Involvement Leave, please contact your Office of Human Resources Representative.
 |  |  |  |  |  | For additional information, please refer to CS Rule 11-130 Parental Involvement Leave.
 |  |  |  | Employee Information
 |  |  |  |  |  |  | Department/Agency |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  |  |  |  |  |  |  | Date of Request
 |  |  |  |  |  |  | Employee Name |  |  |  |  |  |  |  |  | Employee ID Number |  |  |  |  |  |  | [NAME] Number
 |  |  |  | Activity Information
 |  |  |  |  |  |  |  |  |  |  |  | Activity Type:
 |  |  |  |  |  |  | Date of Activity
 |  |  |  |  |  |  | Start Time |  |  |  |  |  | Please Note: Written verification of the meeting from the school or school district is required.
 |  |  |  | Leave Information
 |  |  |  |  |  |  |  |  |  |  |  |  |  | Leave Pay:
 |  |  |  |  |  |  | Total Hours Leave
 |  |  |  |  |  |  | Please note: Parental Involvement leave may only be used in 3 hour increments, not to exceed 6 hours per month, 18 hours per academic year. Parental Involvement leave is pro-rated for part-time employees.
 |  |  |  |  |  |  | * If an employee is requesting Donated Sick but does not currently have any in his/her donated sick bank, employees must contact the Office of Human Resources to start the donated sick request process.
 |  |  |  | Glossary
 |  |  |  |  |  |  | Academic Year: Means the period, not to exceed twelve consecutive months, allotted by a school for the completion of one grade level of study.
 |  |  |  |  |  |  | Eligible employee: Includes all Career Service Employees.
 |  |  |  |  |  |  | Eligible employee's child: Means a child who is enrolled in a public school, private school, or in a non-public home-based educational program, in any grade between kindergarten and twelfth grade, from whom the eligible employee is parent, legal guardian, or is acting in the place of a parent.
 |  |  |  | Official Use Only
 |  |  |  |  |  |  | OHR Representative Signature |  |  |  |  |  |  |  |  |  |  | Date |  |  |  | Payroll Representative Signature |  |  |  |  |  |  |  |  |  |  | Date