University Human Resources
Leave of Absence Inquiry Form
Contact Information
Name
Telephone Number
Workday ID#
Brown Email Address
Role
Faculty
Regular Staff
Research Associate/ Fellow
Seasonal Staff
Student Employee
What is your inquiry about?
FMLA (Intermittent or Continuous)
Medical Leave for Self
Medical Leave for Family
Other Type of Leave (Maternity, Parental, Personal, Military, etc.)
Worker's Compensation
Disability Insurance ( State, Long-Term, etc.)
Accommodations (General, Parking, Pregnancy, Transportation, etc.)
Time-Off Accural
What do you need help with?
Select a question from below. If you select other, please use the space below.
Please select...
I have questions about initiating a Leave of Absence request in Workday.
I have questions about Maternity/ Parental Leave options and benefits.
I have questions about FMLA or State Leave eligibility.
I have questions about compensation while on leave.
I have questions about the required documentation to support my Leave of Absence request.
I have questions about the required documentation to support my Return to work.
I have questions about extending my Leave of Absence beyond FMLA entitlement.
Who approves and manages a Leave of Absence Request?
I have questions about requesting workplace accommodations.
I have questions about Benefits Billing during Unpaid Leave.
I have a question about missing or incorrect paid time-off balances and/or accrual.
Other
Leave of Absence Additional Information
Use this section to include information related to your Leave inquiry or you may ask a question that is not listed above.
Anticipated Leave Dates
Start
End
Are you completing this on your own behalf?
Yes
No
Please enter the name of the person you are inquiring for.
Is this inquiry related to your return from leave due to your own medical condition?
Yes
No
You are welcome to join our virtual office for a confidential consultation to discuss your inquiry. To schedule your appointment, please select the 15-minute time slot that works for you. Once confirmed, a calendar invitation with the Zoom link will be sent to you.
Tuesday at 9am
Tuesday at 2pm
Thursday at 10am
Thursday at 2pm