Employee's Family / Medical Leave Request Process
In order to request a job and benefits protected leave from employment at UMass Amherst:
1 - At least 30 calendar days prior to your leave* (or if medically unable, as soon as practicable), submit a written, signed, and dated request to supervisor, cc your departmental Human Resources representative, indicating:
- That you are requesting a family / medical leave,
- The anticipated dates of your leave (including the date you intend to return to work). If requesting an intermittent leave, the work schedule you propose.
- How you are requesting to secure income. Eg, if leave is approved are you asking your department to submit your sick time? Vacation time? Personal time? Are you requesting unpaid leave?
2- Concurrently or within 15 calendar days thereafter provide your departmental Human Resources representative supporting documentation. Supporting documentation differs based on the reason for leave:
- Parental Leave*
- MSP members please reference the Provost's Office website
- All others for a leave related to:
- Birth of a child or to bond/care for child within 12 months following birth: provide a medical note or birth certificate establishing relationship and child’s date of birth
- Adoption/placement of a child in foster care with you, or bond with/care for a child within 12 months following adoption/placement: legal document establishing date of adoption by/placement with you.
- Your own illness/injury:
Certification of Health Care Provider form for an Employee’s Serious Health Condition - Care for a family member with an illness/injury:
Certification of Health Care Provider form for a Family Member’s Serious Health Condition - Care for a family member whose illness/injury results from active US Military service:
Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave - Your family member being on, or called to, active duty in the US Military:
Certification for Military Family Leave for Qualifying Exigency
These forms are also available from your Human Resources representative and at the Human Resources Employee Service Center (325 Whitmore Admin. Bldg.).
* Birth/adoption/placement of a child is a qualifying event to make changes to your health & dental insurances and enroll/change a Health Care Flexible Spending Account / Dependent Care Assistance Plan. These changes must be completed within 60 days of birth/adoption/placement. You may also wish to review your tax withholdings and life insurance/retirement beneficiaries. Please consult a UMass Human Resources Employee Service Center (room 325 Whitmore Administration Building) representative for more information.