Family and Medical Leave Act (FMLA)
Forms and Resources
- CUNY FMLA Leave Policy
- CUNY FMLA Request Form
- CUNY Certification of Health Care Provider Form for Employees Serious Health Condition
- CUNY Certification of Health Care Provider Form for Family Member’s Serious Health Condition
- CUNY Certification of Family Relationship
- CUNY Certification of Health Care Provider Form for Serious Injury or Illness of a Veteran – Military Caregiver Leave
- CUNY Certification of Health Care Provider Form for Serious Injury of Illness of a Current Service member – Military Family Leave
- CUNY Certification of Qualifying Exigency for Military Family Leave
- CUNY Notice of Eligibility and Rights and Responsibilities
- CUNY Designation Notice
- CUNY Fitness-For-Duty Certification
Non-FMLA Forms and Resources
An employee who may not be eligible for FMLA Leave may apply for Non-FMLA Medical leave.
- CUNY Application for Non-FMLA Medical Leave
- CUNY Non-FMLA Medical Leave Designation Form
- CUNY Non-FMLA Fitness-For-Duty Certification
FFCRA/COVID-19 New York Sick Leave
The Families First Coronavirus Response Act (FFCRA) requires certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to COVID-19. Leave under the Families First Coronavirus Response Act has expired effective September 30, 2021.
Employees who are subject to a mandatory or precautionary order of quarantine or isolation due to COVID 19 are provided with up to fourteen days (10 working days) of paid sick leave at their regular rate of pay with no charge to their accruals. Employees who are able to work remotely are not eligible for this benefit.
Use the link below for more information on New York State’s COVID Leave benefits and eligibility.