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Get LEAP Academy FMLA Request Form

Bsence â–¡with â–¡without pay under the provisions of the Family and Medical Leave Act. I am requesting the leave for the following reason(s): â–¡ â–¡ The Birth of a child, or placement of a child for adoption or foster care A serious injury or health condition affecting my: _____ _____ _____ _____ â–¡ Spouse Child Parent Next of Kin (Only for Military FMLA) A personal health condition Note: A leave request for yourself, family member or next of kin must be submitted with the Certificati.

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