UT Human Resources and Talent Development




Contact Us

Scott Park Campus
Academic Services, Suite 1000

Hours: 8:30 a.m. to 5 p.m.
Phone: 419.530.4747
Fax: 419.530.1490


Family Medical Leave Act Request Forms

*Effective Immediately*

Do not fax to HR or deliver a copy faxed to you, they will not be accepted. 
Only the original completed certification will be accepted in HR.

Watch for the determination of your request on your official UT email address.

Employee FMLA Application and Certification
Family Member FMLA Application and Certification

Military Family Leave Forms
Certification of Qualifying Exigency (WH-384)
Certification for Serious Injury or Illness of Covered Servicemember (WH-385)





Last Updated: 6/9/16