This form should be used if you are a staff member requesting a leave of absence from work when medical, personal, military or other situations arise that prohibit you from working for an extended period of time.
If possible, please submit requests at least 30 days in advance. Otherwise, please complete this form ASAP. Please note that you can also apply for Short Term Disability through the Staff Portal if that applies to you.
Reasons may include medical, family, personal, military, etc.