Leave Request Form

UIN #*

Note: This is not your A#.

Name*

First and Last Name.

Employee Type*

Staff

Faculty

Graduate

Position*

Employee Supervisor*

First and Last Name

Type of Leave*

The birth, adoption or foster placement of a child with you,

Your serious mental or physical health condition that makes you unable to work,

To care for your spouse, child or parent with a serious mental or physical health condition,

Certain qualifying reasons related to the foreign deployment of your spouse, child or parent who is a military servicemember

Employee Comments

If there is any information you would like to include for this request, please take a moment to comment in this section.

Leave Begin Date?*

This is the anticipated start date for leave.

I understand that I responsible for informing my supervisor about my leave.*

I understand as an employee that I am responsible for entering absences in Workday. Paid or Unpaid leave runs concurrent with FMLA and Parental Leave.*

Send me a copy of my responses