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Cornell University Family Leave Provider Verification Form 2017 free printable template

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Medical Leaves Administration Ea s t Hill Office Building Suite 102 395 Pi né Tree Rd., Ithaca, NY 14850 Tel : (607) 2551136 Fa x: (607) 2551888 benefits Cornell.edu www.hr.cornell.eduFamily Leave
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How to fill out Cornell University Family Leave Provider Verification Form

01
Obtain the Cornell University Family Leave Provider Verification Form from the appropriate university website or department.
02
Fill in your personal information at the top of the form, including your name, student ID, and contact information.
03
Provide details regarding the family member for whom you are requesting leave, including their name, relationship to you, and the reason for care.
04
Indicate the dates for which you are requesting leave and any relevant timeframes.
05
Ensure that the healthcare provider completes their section by providing their information and verifying the need for leave.
06
Collect the form once it is fully completed and signed by the healthcare provider.
07
Submit the completed form to the appropriate university office, following any specified submission guidelines.

Who needs Cornell University Family Leave Provider Verification Form?

01
Students at Cornell University who are seeking a family leave of absence to care for a family member.
02
Students who require documentation from their healthcare provider regarding the need for family leave.
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The Cornell University Family Leave Provider Verification Form is a document that serves to verify an employee's family leave request and provide necessary information to the university regarding the leave.
Employees who are taking family leave under the Family and Medical Leave Act (FMLA) or similar policies at Cornell University are required to file this form.
To fill out the form, employees need to provide their personal information, details about the leave, the reason for the leave, and any supporting documents as required.
The purpose of the form is to ensure that the university has the necessary documentation to process family leave requests and to maintain compliance with legal requirements regarding employee leaves.
The form must report the employee's name, department, dates of the leave period, the reason for the leave, and any medical documentation if applicable.
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