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E of Human Resources 100 N Univ Drive, Box 171 Edmond, OK 73034 Phone: (405) 974-2575 or (405) 974-2656 * Fax: (405) 974-3827 (Rev. 02/11) Name: UCO ID# Home Address: (City) (State) Home Telephone: (Zip Code) Work Telephone: Department Name: Campus Box Number: Supervisor s Name: When Family and Medical Leave is needed to care for a seriously-ill family member or service member, the employee shall state the care he or she will provide and an estimate of the time period during which th.

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