Family Medical Leave Act (FMLA)

The CUNY FMLA policy provides eligible employees with up to 12 weeks of unpaid, job-protected leave for qualifying reasons during the designated leave year (i.e., September 1 through August 31). In order to be eligible, an employee must have been employed by the university for at least 12 months cumulatively, and must have worked at least 1,250 hours during the 12-month period preceding the requested commencement of the leave. The employee’s FMLA 12-week leave period entitlement will commence anew from the subsequent period of September 1 through August 31, provided that the eligibility requirements are fulfilled.

The United States Department of Labor has determined that all full-time salaried employees, such as full-time faculty in institutions of higher education, who have worked for the employer for at least 12 months are presumed to have met the 1,250 hours of service requirement for FMLA eligibility.

Employees of the CUNY Research Foundation or any other separately incorporated employer affiliated with CUNY or a CUNY college are not CUNY employees and are not covered by these guidelines.

Please read the policy and procedures below for more information on eligibility, qualifying events, permissible reasons to take FMLA, leave and employee notification responsibilities.

Also see FMLA PowerPoint Presentation.



  1. FMLA Request Form (PDF)
  2. Certification of Family Relationship (PDF)
  3. Certification of Health Care Provider (HCP) for Employee’s Serious Health Condition (PDF)
  4. Certification of Health Care Provider (HCP) for Family Member’s Serious Health Condition (PDF)
  5. Certification for Serious Injury or Illness of a Current Service Member—Military Family Leave (PDF)
  6. Certification for Serious Injury or Illness of a Veteran—Military Caregiver Leave (PDF)
  7. Certification of Qualifying Exigency for Military Family Leave (PDF)
  8. Fitness for Duty Certification (PDF)
  9. Application for Non-FMLA Medical Leave (PDF)
Leave Request For: Complete Forms:
Employee Serious Health Condition 1, 3, and 8
Employee Serious Health Condition (but has taken a leave within the past nine months) 1, 8, and 9
Family Member Serious Health Condition 1, 2, and 4
Military Family Leave 1, 3, and 5
Military Caregiver Leave 1, 3, and 6
Employee Qualifying Exigency for Military Family Leave 1, 3, and 7

Note: FMLA request must be made to HRS at least 30 days in advance if the leave is foreseeable.

Submit forms and any medical documents to:

Bettina Smith
1219 Boylan Hall
P: 718.951.5377

Brooklyn. All in.