Request Leave of Absence

This form should be filled in to submit a request for a formal Leave of Absence.

Please note that this form should only be used to book absences that are longer than four weeks.

If you are simply requesting time off from duties due to holiday or unavailability for a short period of time (e.g. booking time off and asking for a programme to be covered in your absence), please use the Time Off Request form instead.



Please enter your name
Please enter your email address. This MUST be your Black Country Radio email address.
Please enter the most convenient phone number to reach you on



Please enter a start and end date for your leave of absence. Please note that the maximum duration for a Leave of Absence is six months. If you do not know the end date, please estimate this as it can be reviewed nearer the time. If you feel your Leave of Absence may be longer than the maximum six months, or even indefinite, please ensure you book it initially for no longer than six months. Towards the end of this time period, the Head of Volunteer Management will review it and consider an extension if necessary. Absences which are booked via this form for longer than six months will be rejected.



We ask you to give a reason simply to give us context as to why you are booking a Leave of Absence. You are not required to give a reason. If you do not wish to give a reason, please select 'Prefer not to say' from the drop-down menu below. Any reasons or information you provide will be shared only with the Head of Volunteer Management and kept confidential.

If you selected 'Other' above, please type a brief reason here
If you wish to include any additional information, please do so here

Please ensure that the duration of your Leave of Absence is for a maximum of six months.

Please tick the box below then press the "Submit Request" button to send your Leave of Absence Request.

This will be submitted to the Head of Volunteer Management.

You will receive a copy of what you have submitted via email to your Black Country Radio email address.