System-wide Forms
Certifications, Notices, and Other Forms
- Certifications
- Certification of Health Care Provider for Employee’s Serious Health Condition
- Certification of Health Care Provider for Family Member’s Serious Health Condition
- Certification of Health Care Provider for Employee’s Pregnancy Disability
- Return to Work Certification
- Certification For Qualifying Exigency Leave
- Certification for Military Caregiver Leave
- Notices
- Other
UC Irvine
Forms, Instructions, and Checklists
- Checklists
- Instructions
- Forms
- Sabbatical Leave of Absence Form (UCI-AP-75)
- Leave of Absence Form (UCI-AP-76)
- Modified Duties Request/ Certification Form (UCI-AP-91)
- Childrearing Stop the Clock Certification Form (UCI-AP-92)
- Request for Funding for Ladder Rank Faculty Teaching Release for Birth or Adoption of Child(ren) (UCI-AP-93)