409.3E2 Employee Family and Medical Leave Request Form

Denison Community School District uses the forms found on the United States Department of Labor website for Family and Medical Leave Act.

·       WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition (PDF)

·       WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition (PDF)

·       WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)

·       WH-382 Designation Notice (PDF)

Date Board Adopted 5/9/1994

Date Board Reviewed 2/21/2022