FMLA, LONG TERM SUBSTITUTE OR NEW TEACHER GRADEBOOK ACCESS REQUEST FORM  
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Email *
CAMPUS *
ACCESS REQUESTED FOR: *
Required
TEACHERS FULL NAME NOT APPEARING ON THE CAMPUS STAFF ROSTER.
TEACHERS FULL NAME ON FMLA IF APPLICABLE
LT SUB OR FMLA SUB START DATE (actual date teaching in the classroom) *  Dates are also used to determine substitute assignment access date allotment for FMLA substitutes. *
MM
/
DD
/
YYYY
LT SUB OR FMLA END DATE. *Actual dates are important for PEIMS reporting *
MM
/
DD
/
YYYY
SUBSTITUTES FULL NAME (LAST, FIRST & MIDDLE NAME) NO NICKNAMES *
SUBSTITUTES ESS EMPLOYEE ID *Usually start with a "T".
DISTRICT or PERSONAL  EMAIL ADDRESS *
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