NASA Headquarters' Directives
HQPR 3611.1 Effective Date: October 25, 2007 Expiration Date: October 25, 2012 Cancellation Date: April 19, 2012 Responsible Office: LM	Telework Program [CANCELLED]

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APPENDIX B. INITIAL TELEWORK REQUEST

I, _____________________, request approval to telework using the following option: (choose one)

_____ Core telework

_____ Episodic telework

1. I would like to start teleworking on (for core teleworking only) ______________________.

2. The address of my alternative worksite will be:

3. (For core teleworking only) My core telework days will be:

4. While I am teleworking, I will be available on: (phone number and/ or email address)

5. I have read the Headquarters Procedural Requirements for the Telework Program and agree to comply with all of its provisions.