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 C: EPISODIC TELEWORK E-MAIL REQUEST

1. I am requesting approval for episodic telework on _ (day) ___________ for __________ hours to accomplish the following tasks:

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

3. The address of my alternative worksite will be:

4. I will provide a summary of the tasks accomplished during the telework time period approved.

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