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Every Student Matters

FMLA Guidelines

FMLA provides unpaid, job-protected leave. Leave may be taken all at once or intermittently as the medical condition requires. An allowance of 12 weeks (84 days) off if you meet this criterion:
Must have worked at least 12 months and at least 1250 hours in the 12 months before you take leave.

Thirty (30) days’ notice of your need to take FMLA is required. Notice from doctor, hospital, military within 15 business days of submitting completed FMLA form. Please note, all referenced forms can be found in the files to the right.

Qualifying reasons for FMLA are:

  • Childcare or care of immediate family member
  • Maternity
  • Medical leave
  • Military family leave
  • Paternity

FMLA is an unpaid leave. However, if you have sick time or personal time, you may use that time, along with FMLA leave in order to continue to get paid. Sick time used runs concurrently with FMLA time used. If you have available sick or personal time that exceeds the FMLA days you’ve used, you can continue to use that time in order to remain being paid.

District health benefits will remain in effect while you are on payroll which means your normal premiums will not change. If you are off payroll at any time while you are on a leave of absence, your district benefit premiums will change. See your Health and Benefits administrator for more information regarding both topics.

FMLA Applications

Guidelines at a Glance

Purpose Requirements Time off Sick, Personal, Vacation time Calendar Days counted Returning
Medical Certification for Health Care Provider Form WH-380-E; Completed and properly signed FMLA form 84 days per 12 months. *See above. Can be used to stay on payroll.  Certification for Health Care Provider Form WH-380-E is required in order to use sick time. Only work days are counted Doctor’s note upon return
Maternity Certification for Health Care Provider Form WH-380-E; Completed and properly signed FMLA form.  Notice of child’s DOB a.s.a.p. in order to calculate recovery portion of FMLA days. 84 days per 12 months. *See above. Note: 6 weeks recovery for natural birth; 8 weeks recovery for C-section Can be used to stay on payroll.  Certification for Health Care Provider Form WH-380-E is required in order to use time accrued. Only work days are counted Doctor’s note upon return
Paternity Certification for Health Care Provider Form WH-380-E; Completed and properly signed FMLA form 84 days per 12 months.  *See above. Can be used to stay on payroll.  Certification for Health Care Provider Form WH-380-E is required in order to use time accrued. Only work days are counted No note required.
Child or Immediate Family Certification for Health Care Provider Form WH-380-F showing you are primary care-giver; Completed and properly signed FMLA form 84 days per 12 months.  *See above. Can be used to stay on payroll. Certification for Health Care Provider Form WH-380-F is required in order to use time accrued. Only work days are counted No note required
Military Family Leave Certification of Qualifying Exigency form WH-384; and/or Certification for Serious Injury or Illness of a Current Servicemember Form WH-385 Completed and properly signed FMLA form 84 days and may take up to 26 weeks of FMLA leave in a single 12-month period to care for a covered service member with a serious injury or illness. Can be used to stay on payroll.  Certification of Qualifying Exigency Form WH-384 is required to stay on payroll. Only work days are counted Doctor’s note required if you’ve completed a Form WH-385