Leaves In-Take Form

The Leaves Coordinator will follow up with you regarding your request and answer any questions you may have. If requesting a medical leave for your own medical needs or to care for a family member, a medical certification from the healthcare provider will be required. If so, the Leaves Coordinator will provide the form.


Employees are responsible for reporting absences to their HEERA manager, chair, and/or Dean in a timely manner and provide them with the duration of their leave. To learn more about the procedure for taking a leave of absence, visit Leave of Absence Procedures for Employees.