TO:                  Name, CNM President

VIA:                 Name, Supervisor

FROM:            Name, Job Title

DATE:

SUBJECT:       Request for Leave of Absence Without Pay to Participate in Political Activities

In accordance with CNM policies, I request an unpaid leave of absence from (date to date).  The leave is requested so that I can participate in political activities.  I understand that this leave shall comply with Section 8.16 of the Employee Handbook.

I will contact the Human Resources Department at least two weeks before my scheduled date to return to work.

RECOMMENDED:

_____________________________
Supervisor                                Date

RECOMMENDED:

_____________________________
Department director/Dean        Date

RECOMMENDED:

_____________________________
Vice President                           Date

APPROVED:

_____________________________
President                                   Date

xc:  Human Resources Department