LEAVE OF ABSENCE REQUEST FORM  - Madison Metropolitan School District
Please fill this form out completely, and in advance of the leave where possible.  The Employee Handbook references any applicable deadlines.  Contact the Leaves Division if you have questions about completing this form at LEAVES@madison.k12.wi.us . Please note, the following Medical Certification Forms can be found below, but we will reach out to you to advise what may be needed. 
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Email *
EMPLOYEE INFORMATION
ALL ITEMS REQUIRED
Full Name *
Please include first and last name
Employee Number *
7xxxxx   (Do not include the 'b')
Email address during leave *
Please provide an external, non-MMSD email address where we can contact you during a leave of absence.
Phone number during leave *
Please provide an external, non-MMSD phone number where we can contact you during a leave of absence.
Home address during leave *
Please provide your current home address where we can contact you during a leave of absence.
Work Location *
Supervisor Name *
Position Title *
Regular Work Schedule  (List days of the week and hours per day worked): *
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