Skip to main content Skip to main navigation Skip to footer content


Thank you for filling out the form!

Click here to download/print this page

Your medical leave of absence request has been received. Your assigned leave coordinator, Donna Freeman, will contact you within two (2) business days to schedule an appointment to review your request.

1. Complete Section 1 and 2 of the Medical Leave Application form prior to your meeting with your leave coordinator.

2. Sections 3 and 4 will be completed with you at your scheduled meeting. Program eligibility and usage of your leave credits will be discussed with you before completing these sections.

3. Once you have met with your leave coordinator and Sections 1-4 have been completed, please forward your Medical Leave Application to the Dept. Chair/Manager, Dean/Dept. Manager, and then Human Resources.

4. All required documents will be provided to you during your appointment. A checklist of the required document(s) and a deadline date to return these documents to Human Resources will be provided by the leave coordinator.

5. If you are off work, the leave coordinator will contact you to discuss what leave programs you are eligible for and the appropriate usage of your available leave credit. A letter will be mailed to you with the required document(s), checklist and deadline date. Please mail, FAX or scan the required document(s) back to your leave coordinator.

Human Resources
Joyal Administration Bldg. Room 164
5150 N. Maple Avenue M/S JA71
Fresno, CA 93740
FAX (559) 278-4275

6. On-going communication between you, your manager, and your leave coordinator is important to ensure a smooth transition to and from your leave.

Click here to download MEDICAL LEAVE APPLICATION form.

Should you have an immediate concern, please call Human Resources at (559) 278-2032.

Medical Leaves of Absence

Types of Leave Programs

Usage of Leave Credits

Roles and Responsibilities

Assigned Leave Coordinator

Initiate a Leave of Absence


Leave Related Forms


Medical Leave Application

Rights and Responsibilities

Certification of Health Care Provider for Employee

Certification of Health Care Provider for Family Member

Certification of Health Care Provider for Paternity

Notice & Request Form


How to File a Claim


Catastrophic Leave

Option Sheet