Leaves of Absence
FMLA Forms and Documents
- FMLA Policy
- Your rights under FMLA
- FMLA Request Form (Fillable Form)
- Medical Certification Statement (Employee)
- Medical Certification Statement (Family Member)
- Fit for Duty Certificate
- Supervisor FMLA Responsibilities
Non-Qualified Medical Leave of Absence
In the event an employee needs to take a leave of absence for his/her own illness, and the employee is ineligible for the Family Medical Leave Act (FMLA), it is within the discretion of the employee's supervisor, administrator, or dean to grant an unpaid medical leave of absence. Request forms may be obtained from the Human Resources Department, 280-2709.
While on a non-qualified medical leave, the employee's position is not protected by law.
If the employee participates in the group disability insurance plan and his/her illness extends beyond 30 calendar days, the employee may be eligible to receive paid disability benefits during the leave. Employee must coordinate application for disability benefits with Human Resources, if applicable. For more information on group disabiltiy benefits, please go to the Long Term Disability page.