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Employee Request for Leave

The University chooses to provide very liberal leave policies under the Family Medical Leave Act (FMLA) and for Maternity, Adoption and Parental Leave (Paternal Leave).  Information on the FMLA policy and the Paternal Leave policy can be found in the Employee Handbook.    

To facilitate a leave under one of these policies:

1. Complete this form and hit submit (will forward to Human Resources)

2. Provide Documentation

Leave due to Medical needs:  FOR YOURSELF, ask a physician to fill out this form and return it to the Human Resources office.

Leave due to Medical needs of YOUR SPOUSE, DEPENDENT, PARENT:  Ask a physician to fill out this form and return it to the Human Resources office. 

MILITARY:  Special federal forms are used to cover leaves related to military service members.  For injured family member, please use this form.  For an exigency, please use this form.

ADOPTION, JURY DUTY OR DEATH OF A FAMILY MEMBER: Provide documentation/certification