Catastrophic Leave Authorization Form

UW-Madison has a Catastrophic Leave Program that enables employees to donate some of their leave to an employee in need. If you would like to make a donation you will need to complete a Catastrophic Leave Authorization Form.

File: CatastrophicLeaveDonorAuthorization.doc

UW-Madison has a Catastrophic Leave Program that enables employees to donate some of their accrued vacation, vacation carryover, personal/floating holiday, or banked leave to an employee in need. Sick leave may not be donated.

If you would like to make a donation, you will need to download and complete a Catastrophic Leave Authorization Form and return it to Rebecca Rohde in FP&M Payroll at rebecca.rohde@wisc.edu.

Download


For more details, please review UW-Madison’s Catastrophic Leave Policy. This policy applies to Faculty, Academic Staff, University Staff, and Limited Appointees.

Please contact Rebecca Rohde, FP&M Payroll Supervisor, at rebecca.rohde@wisc.edu or by phone at 262-6218 if you are interested in learning more about this program or making a donation.

FMLA Form for Family Member (WH-380F)

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave to care for a family member with a serious health condition to submit a medical certification issued by the family member's health care provider.

File: WH-380-F_FMLA-for-Family-1.pdf

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave to care for a family member with a serious health condition to submit a medical certification issued by the family member’s health care provider. Complete this form and send to Rebecca Rohde at rebecca.rohde@wisc.edu or to our FP&M HR fax number: 608-265-3692.

FMLA Form for Employee (WH-380E)

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider.

File: WH-380-F_FMLA-Form-for-Employee-1.pdf

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. Complete this form and send to Rebecca Rohde at rebecca.rohde@wisc.edu or to our FP&M HR fax number: 608-265-3692.