This form is for System Administration Employees Only. Please contact your campus HR for information about FMLA for your campus. 

You must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable.  When 30 days’ notice is not possible, you must provide notice as soon as practical and generally must comply with normal call-in procedures.

This form is the initial step in processing your request for FMLA.  In order to determine whether you are eligible, Human Resources will ask for documentation of your medical condition.

For more information on the Family and Medical Leave Act and to understand this employee benefit, please take the CU: Family Medical Leave Skillsoft course.  This course will cover regulations, eligibility and compliance, paperwork, accessing the forms, and the nuances of the law.

This form will only be viewed by persons in Human Resources.  Employees who have questions prior to submitting the form may contact Human Resources at

If you are requesting leave for the care of a family member, or due to a qualifying exigency please choose the family relationship.