Leave Forms

Select the appropriate leave form. Some forms are university specific.

Administrative Leave
Administrative Leave Application: PDF Format | MS Word

Family and Medical Leave
FMLA Application: PDF Format | Rich Text Format
FMLA Medical Certification - Employee: PDF Format | Rich Text Format
FMLA Medical Certification - Family Member: PDF Format | Rich Text Format
FMLA Medical Certification - Covered Service member: PDF Format | Rich Text Format
FMLA Certification of Qualifying Exigency for Military Family Leave: PDF Format | Rich Text Format
FMLA/UFML/VESSA Usage Report (MS Excel Format)

Sabbatical Leave
Application Form

Leave of Absence Information and Form
Leave of Absence Information (PDF)
Leave of Absence Worksheet (PDF form to be ​completed online before printing​.  If the PDF fails to load, then download and complete the form before printing.)

Shared Benefits Program
Online Donation of Leave Form
Withdrawal Form

Sick Leave
Transfer of Cumulative/Noncompensable
Sick Leave Waiver Form

University Family Medical Leave (UFML) for Registered Same-Sex Domestic Partners
University of Illinois Affidavit of Domestic Partnership
UFML Application: PDF Format | Rich Text Format
Medical Certification - Family Member: PDF Format | Rich Text Format
Medical Certification - Covered Service member: PDF Format | Rich Text Format
Certification of Qualifying Exigency for Military Family Leave: PDF Format | Rich Text Format
FMLA/UFML/VESSA Usage Report (MS Excel Format)

VESSA Leave
VESSA Application: PDF Format | Rich Text Format
Medical Certification - Employee: PDF Format | Rich Text Format
FMLA/UFML/VESSA Usage Report (MS Excel Format)

University-Specific Forms
Urbana: Leaves of Absence Without Pay (LWOP) (Faculty and APs)

Chicago: Special Leave Form