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REQUEST FOR MEDICAL LEAVE OF ABSENCE (This form should be completed and given to your deans office.) PLEASE PRINTTodays Date: Name: (Last) (First) (Middle) Class Level: International Student? No SSN

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What is request for medical leave?

Request for medical leave is a formal application made by an employee to their employer to take time off work for medical reasons.

Who is required to file request for medical leave?

Any employee who needs to take time off work for medical reasons is required to file a request for medical leave.

How to fill out request for medical leave?

To fill out a request for medical leave, the employee must provide details of their medical condition, the expected duration of the leave, and any supporting documentation from a healthcare provider.

What is the purpose of request for medical leave?

The purpose of request for medical leave is to inform the employer of the employee's need to take time off work for medical reasons and to request approval for the leave.

What information must be reported on request for medical leave?

The request for medical leave must include details of the employee's medical condition, the expected duration of the leave, and any supporting documentation from a healthcare provider.

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