Leave Forms

Select the appropriate leave form. Some forms are campus 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 Information (Rich Text Format)
Leave of Absence Form (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 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)

Campus-Specific Forms
Urbana: Leaves of Absence Without Pay (LWOP) (Faculty and APs)
Chicago: Special Leave Form