Request for Family & Medical Leave

**FOR INTERNAL EMPLOYEE USE ONLY UNIVERSITY OF MARYLAND, COLLEGE PARK**

If you have any problems opening any of the forms below please contact Staff Relations at (301) 405-0001.

Steps to Open the On-Line FML REQUEST FORM

  1. (Faculty)  Leave forms are online in the Faculty Handbook
  2. (Staff) Simply click on the link for the FML Request Form to open the document.
  3. Employee’s OWN Serious Health Condition
  4. FAMILY MEMBER’S Serious Health Condition
  5. Certification of Qualifying Exigency for Military Family Leave
  6. Certification for Serious Illness or Injury of Covered Service Member
  7. Complete the forms by either filling it out on-line or print a hard copy to complete manually. Either method will require a submission of a hard copy with original signatures.
  8. Retain original form for your departmental records. Please forward a copy to University Human Resources, Staff Relations, 3100 Chesapeake Building.

Last updated: September 23, 2016