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Leave Related to Pregnancy, Childbirth and/or Recovery; and Parental leave -- Completing the form for Faculty & Academic Staff

Completing the LEAVE OF ABSENCE form for Short-Term Disability Leave Related to Pregnancy, Childbirth and/or Recovery;  and Parental leave

1. Birth-mother provides medical certification indicating a projected delivery date of May 1, 2001 and requests that her leave begin 2 weeks before the projected delivery.

   Parental leave runs 2 weeks 4/17/01 - 4/30/01.
   Short-Term Disability leave runs 6 weeks 5/1/01 - 6/11/01.
   Parental leave runs 4 weeks 6/12/01 - 7/9/01.

   Pay Dates of Leave:  From    4/17/2001   Through   7/9/2001

   Type of Leave - Check all boxes that apply:
   Short Term Disability
   Parental From  4/17/01  To  4/30/01 ;  From   6/12/01  To   7/9/01
    

2. Birth-mother provides medical certification specifying that she is unable to work from March 15, 2001 through June 15, 2001 due to birth of child expected May 1, 2001.  She requests that the leave begin March 15, 2001.

   Short-Term Disability leave runs 3/15/01 - 6/15/01.
   Parental leave runs 6 weeks  6/16/01 - 7/27/01.

   Pay Dates of Leave:  From    3/15/2001    Through    7/27/2001

   Type of Leave - Check all boxes that apply:
   Short Term Disability
   Parental From  6/16/01   To  7/27/01 ; From _________ To _________
    

3. The birth-mother in #2 above is appointed on an academic year (AY) basis and requests that non-duty days be excluded from her leave.

   Short-Term Disability leave runs 3/15/01 - 6/15/01.
   Parental leave runs 6 weeks during duty days 8/16/01 - 9/26/01.

   Pay Dates of Leave:  From    3/15/2001    Through    9/26/2001

   Type of Leave  - Check all boxes that apply:
   Short Term Disability
   Parental From   8/16/01   To   9/26/01  ; From _________ To _________
    

4. Adoptive parent provides evidence of date of adoption as April 1, 2001 and evidence of age of child as one year old, and requests that the leave begin April 24, 2001.

   Parental leave runs 6 weeks 4/24/01 - 6/4/01.
    

   Pay Dates of Leave:  From    4/24/2001    Through    6/4/2001

   Type of Leave  - Check all boxes that apply:
   Parental From 4/24/01   To  6/4/01 ; From ________ To  ________
    

5. The adoptive parent in #4 above is appointed on an academic year (AY) basis and requests that the parental leave clock stop during the non-duty days.

   Parental leave runs 3 weeks 1 day 4/24/01 - 5/15/01, and 2 weeks 6 days 8/16/01 - 9/4/01.

   Pay Dates of Leave:  From    4/24/2001    Through    9/4/2001

   Type of Leave  - Check all boxes that apply:
   Parental From  4/24/01   To  9/4/01 ; From ________ To  ________
    

6. Adoptive parent provides evidence of date of adoption as April 1, 2001 and evidence of age of child as three years old, and requests that the leave begin March 26, 2001 and that she/he work 50% time for a 12-week period while on parental leave.  The unit administrator agrees that the intermittent leave is in the best interests of the unit.

   Parental leave is for 50% time for the 12-week period of 3/26/2001 to 6/17/01.

   The details of the intermittent arrangement may be shown on the Leave of Absence form on the comments lines, or they may kept in the department only and not appear on the form.  However, the dates on the leave form should reflect a six-week leave period starting with the first day of the intermittent leave.
    

   Pay Dates of Leave:  From    3/26/2001    Through    5/6/2001

   Type of Leave  - Check all boxes that apply:
   Parental From  3/26/01   To  5/6/01 ; From ________ To  ________

   Comments:  At the department’s discretion the 50% time for the 12-week period of 3/26/2001 to 6/17/01 can be referenced on the Comments line.
    

7. Parent provides evidence of birth of child on March 1, 2001 and requests leave in three two-week increments.  3/1/01 to 3/14/01,  4/1/01 to 4/14/01, and 5/1/01 to 5/14/01.   The unit administrator agrees that the intermittent leave is in the best interests of the unit.

   Parental leave is for three two-week periods  3/1/01 to 3/14/01,  4/1/01 to 4/14/01, and 5/1/01 to 5/14/01.

   The details of the intermittent arrangement may be shown on the Leave of Absence form on the comments lines, or they may kept in the department only and not appear on the form.  However, the dates on the leave form should reflect a six-week leave period starting with the first day of the intermittent leave.
    

   Pay Dates of Leave:  From    3/1/2001    Through    4/11/2001

   Type of Leave  - Check all boxes that apply:
   Parental From  3/1/01   To  4/11/01 ; From ________ To  ________

   Comments:  At the department’s discretion the three two-week periods  3/1/01 to 3/14/01,  4/1/01 to 4/14/01, and 5/1/01 to 5/14/01 can be referenced on the Comments line.
    

8. Birth-mother provides medical certification indicating a projected delivery date of March 1, 2001 and requests that her leave begin March 1, 2001.
   The other parent is also an MSU faculty/academic staff member and provides a copy of the projected delivery date document and requests a 3 week leave beginning March 1, 2001.

   Mother’s Leave of Absence:

   Short-Term Disability leave runs 6 weeks 3/1/01 - 4/11/01.
   Parental leave runs 3 weeks 4/12/01 - 5/2/01.
    

   Pay Dates of Leave:  From    3/1/2001    Through    5/2/2001
   Type of Leave - Check all boxes that apply:

   Short Term Disability
   Parental From  4/12/01   To  5/2/01 ; From _________ To _________
    

   The other parent’s Leave of Absence:

   Parental leave runs 3 weeks 3/1/01 - 3/21/01.

   
   Pay Dates of Leave:  From    3/1/2001    Through    3/21/2001

   Type of Leave  - Check all boxes that apply:
   Parental From  3/1/01   To  3/21/01 ; From ________ To  ________