University of Illinois System

Leave Forms

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

Administrative Leave
Administrative Leave Application: PDF Format | MS Word

Child Extended Bereavement Leave
Leave Application: Child Extended Bereavement Leave: PDF

Family and Medical Leave
Leave Application: Family and Medical Leave / Parental Leave / Unpaid Family Bereavement Leave: PDF
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
U of I Leave Usage Report (MS Excel Format)

In Loco Parentis Verification
Verification of In Loco Parentis Status

Leave of Absence Information and Form
Benefits Leave of Absence Information (PDF)
Benefits Leave of Absence Worksheet (PDF)

Parental Leave
Leave Application: Family and Medical Leave / Parental Leave / Unpaid Family Bereavement Leave: PDF
U of I Leave Usage Report (MS Excel Format)

Sabbatical Leave
Application Form

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
U of I Leave Usage Report (MS Excel Format)

Unpaid Family Bereavement Leave
Leave Application: Family and Medical Leave / Parental Leave / Unpaid Family Bereavement Leave: PDF
Family Bereavement Leave Act 10(a)(4) Leave Form
U of I Leave Usage Report (MS Excel Format)

VESSA Leave
VESSA Application: PDF Format | Rich Text Format
Medical Certification - Employee: PDF Format | Rich Text Format
U of I Leave Usage Report (MS Excel Format)

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