Application for Leave of Absence

Service Overview

Use this form to request a leave for the following reasons:

Employee's serious medical condition (staff or faculty)
To care for a spouse, child or parent with a serious medical condition (staff or faculty)
Birth of a child or to care for a newborn child (staff only)
Adoption or foster care of a child (staff or faculty)
Military leave (staff or faculty)
Personal leave for reasons not listed above (staff only)

Full-time faculty members applying for a sabbatical, parental leave, or non-FMLA personal / research leave should complete the Faculty Leave and Sabbatical Request instead of this form.

Submit requests in sufficient time before the date of leave requested so appropriate consideration may be given in a timely manner. Your request will be routed to the appropriate individuals for approval, depending on the type of leave.

Submit appropriate documentation directly to Human Resources by uploading a copy to the secure HR folder, via email to benefits@udayton.edu, faxed to 937-229-2569, sent via campus mail to campus zip +1649, or delivered in person to 315 St. Mary’s Hall.

Family and Medical Leave: The University of Dayton Medical Certification Form (.pdf) MUST be completed by the attending healthcare provider and submitted per the instructions above. All medical information will be kept confidential and maintained in a separate file in the Office of Human Resources. Should you need to extend your leave of absence, you must submit an updated Medical Certification form and a new Application for Leave of Absence to the Office of Human Resources for consideration. For more information, refer to the Family & Medical Leave Act and Leave of Absence policies in the appropriate Benefit and Leave of Absence Handbook. Requests for intermittent leave must also be submitted using this process.
Military Leave: You must submit a statement from the military fiscal officer or a copy of your military orders. You must provide proof of pay information to be considered for any pay differential during military leave.
For proof of pay submission:
- Non-UDRI employees: Send to payroll@udayton.edu
- UDRI employees: Send to timecard@udri.udayton.edu
For more information, refer to the Military Leave policy in the appropriate Benefit and Leave of Absence Handbook.
Personal / Other Leave: In some cases, the Office of Human Resources may ask you to provide additional information from the appropriate source(s) for verification. Such leave requests may be granted on a case-by-case basis in consultation with the Office of Human Resources without pay and generally require the employee to have completed one year of service before being considered. For more information, refer to the Leave section of the appropriate Benefit and Leave of Absence Handbook.

For detailed information about Leaves of Absence available to benefit eligible employees, please refer to the Leave of Absence section of the appropriate Benefits and Leave of Absence Handbook.

IMPORTANT: To ensure continuation of University benefits, you must contact the Office of Human Resources before beginning a leave of absence.