Leave Request Form Leave Request Form Name* First Last Email* FMLA-Qualifying Event No Yes For 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* MM slash DD slash YYYY Begin Time* : Hours Minutes AM PM Return-to-Work Date* MM slash DD slash YYYY Return-to-Work Time : Hours Minutes AM PM Total Hours Requested* Please round to the closest .25, .50, .75, or whole hour increment as appropriate.Additional Comments
