Memorial Presbyterian Church

Tithe and Offering

Staff Modified Work Schedule Request Form

Employee Name

First Name

Last Name

Supervisor Name

First Name

Last Name

Date Submitted

MM

DD

YYYY

Week Affected

MM

DD

YYYY

Description of Change:

Reason:

Normal Schedule (start-end time):

Requested Schedule (start-end time):

Supervisor Approval

First Name

Last Name

Date

MM

DD

YYYY

Comments: