Clover Park School District

Leave of Absence

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Leave of Absence | On-the-Job Injury | Employee Accommodations

To Apply for a Leave of Absence

Pease review the documents and applications below, and then complete the appropriate forms and submit to:

Cherie Broeker
Clover Park School District
Human Resources
10903 Gravelly Lake Dr SW
Lakewood WA 98499
[email protected]
253-583-5120 or FAX 253-583-5088

To Report an On-the-Job Injury

To Request an Employee ADA Accommodation

All requests for employee accommodations (temporary or permanent) should begin with the Human Resources Accommodations Coordinator. Please email your accommodation request for your disability (temporary or permanent) to:

Cherie Broeker
[email protected]
253-583-5120

The HR Coordinator for Employee Accommodations will initiate the interactive accommodation process. As part of the interactive process:

Forms will be sent to employee for completion prior to an accommodation meeting.
- One form will be for employee’s physician to complete regarding his/her disability.
- One form will be for the employee to complete regarding his/her disability.
After HR receives the forms, HR will schedule a meeting with employee and respective administrator to review the accommodation request and the essential functions of the employee’s position to determine how best to proceed.
If approved, an accommodation plan is then sent to an employee summarizing the accommodation.

10903 Gravelly Lake Drive SW, Lakewood, WA 98499

Phone:253-583-5000

Clover Park School District

Clover Park School District does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal, and provides equal access to the Boy Scouts and other designated youth groups. Address correspondence to one of the following individuals who have been designated to handle questions and complaints of alleged discrimination at Clover Park School District, 10903 Gravelly Lake Dr., SW, Lakewood, WA 98499-1341: Title IX Coordinator, Section 504/ADA Coordinator, Civil Right Compliance Coordinator Greg Davis, Executive Director of Compliance and Student Services Contact the Executive Director of Compliance and Student Services (253) 583-5154. Title IX inquiries may also be directed toward the U.S. Department of Education, Office for Civil Rights(OCR). Information about the district's nondiscrimination and sex-based discrimination policies and grievance procedures, and how to report a concern or complaint can be found here.