Non Clinical Faculty Leave Request

Non Clinical Faculty Leave Request Form

"*" indicates required fields

LEAVE INFORMATION

Name*
MM slash DD slash YYYY
MM slash DD slash YYYY
If this is a regarding a new FMLA event that has not been approved, please submit the initial intake form at https://benefits.hr.ufl.edu/time-away/fmla/fmla-preliminary-request-form/

ACADEMIC LEAVE INFORMATION

MM slash DD slash YYYY
MM slash DD slash YYYY

Required Signatures