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RETURN COMPLETED FORM TO THE BUSINESS OFFICELEAVE OF ABSENCE REQUEST FORM
EMPLOYEE INFORMATIONLEAVE TYPE
(SELECT ALL THAT APPLY)Homesick/Medical (10+ days)
(Require Certification of Health Care Provider
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Return completed form to the designated department or individual specified on the form.
Who is required to file return completed form to?
Individuals or entities specified on the form are required to file the completed form.
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