Follow the steps to successfully complete your request for leave without pay.

1. Click the ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by entering your employee name in the designated field. Ensure that you print clearly to avoid any misunderstandings.
3. Input your Social Security number in the next field. This information is necessary for identification purposes.
4. Fill in your mailing address, including the city, state, and ZIP code to ensure accurate correspondence.
5. Provide your home and work telephone numbers in the respective fields. This information may be required for follow-up communication regarding your request.
6. Indicate your work location clearly. This helps the administration process your request effectively.
7. Enter the name of your supervisor as requested. This ensures that your supervisor is aware of your leave request.
8. Specify your current percentage of effort in your role. This provides context for your request.
9. Include your date of employment to establish your eligibility for leave.
10. In the 'Reason for Leave' section, briefly explain the reason for your request. Be concise and relevant.
11. If you have any additional requests, such as a temporary reduction in effort, describe them in the appropriate section.
12. Fill in the anticipated dates of your leave, specifying both the beginning and return dates.
13. If applicable, indicate how many hours of personal leave, holiday leave, or vacation time you wish to use during your leave.
14. Check the box if this leave is an extension of short-term disability leave. This information is crucial for administrative purposes.
15. Read through the guidelines regarding leave without pay to fully understand the terms before proceeding.
16. Complete the health insurance certification section if you wish to maintain your health and dental insurance coverage during your leave.
17. Sign and date the employee certification section to confirm you understand the leave rules.
18. Obtain the necessary approvals by having your project director and the research institute sign the designated areas.
19. Ensure that the personnel office verifies your time and accruals and checks your health insurance premiums.
20. Once all sections are completed, save any changes, then download, print, or share the form as required.

Complete your NY Research Foundation For Mental Hygiene Request For Leave Without Pay online today.