Leaves of Absence Forms and Policies

There are times when you may need to be away from your job for an extended period of time because of illness, family obligations or other reasons. 

Your benefits may be impacted should you need to take a leave of absence.  For additional information, please consult the University of Chicago policy that pertains to the leave of absence for which you are applying.

Policies

• 522 FMLA Policy

• 515 Medical leave of Absence Policy

• 508 Personal Leave of Absence Policy

• 526 Victims' Economic Security and Safety Leave

FAQs and Fact Sheet

• STD FAQ and Fact Sheet

• Paid Parental Benefit FAQ and Fact Sheet

• LTD FAQ and Fact Sheet

The University has a wide range of leaves of absence designed to address your needs for time away from work. If you need to request a leave, please start by completing the Leave Request Form below. 

Request Leave of Absence - QRG and Forms

• Request Leave of Absence QRG

• WH 380 E Certification of Employee Healthcare Provider

• WH 380 F Certification of Family Healthcare Provider

• WH 384 Certification of Qualifying Exigency for Military Family Leave

• WH 385 Certification of Injured Current Service Member Health Care Provider

• WH 385V Certification of Injured Veteran Service Member Health Care Provider

• Return to Work Certification

Long-Term Disability (LTD)

• How to File an LTD Claim Form

Workers' Compensation (WC)

• 525 Workers' Compensation Policy

• Worker's Compensation Rights and Responsibilities

• Request for Treatment (Form 100)

• Employee's Statement of Illness or Injury

• Supervisor's First Report of Injury/Illness

• Accrual Option Form

• Authorization to Release Information