Leave Request Form Leave Request Form Name* First Last Email* FMLA-Qualifying EventNoYesFor partial days, or a combination of leave types, please provide details in the additional comments below.Type of Leave* Vacation Sick Other Leave Begin Date* Begin Time* : HH MM AM PM Return-to-Work Date* Return-to-Work Time : HH MM AM PM Total Hours Requested*Please round to the closest .25, .50, .75, or whole hour increment as appropriate.Additional Comments
