Date

Dr. Valerie Kelsey, Superintendent
Schalmont Central School District
4 Sabre Drive
Schenectady, New York 12306

Dear Dr. Kelsey:

My physician has advised me that I am pregnant and the term of pregnancy is estimated to extend to (due date), my projected due date. I am further advised that as the time of delivery approaches, I will become temporarily disabled and thus not fit to perform my teaching duties. It is my intention to use a portion of my accumulated sick days to cover this disability period. (At this time I am also requesting the use of sick pool days to cover that portion of my disability period not covered by my accumulated sick days)

Pending a successful delivery, I may apply for a maternity leave of absence, commencing at the end of my disability period. I will inform you of my exact intentions regarding this leave as soon after the birth as possible.

It is my intention to keep the school district informed of the circumstances surrounding my pregnancy.

Sincerely,

Name