• Request for Family and Medical Leave
  • Click to view form (pdf or doc) »
  • UK HealthCare employees should submit paper copies of the form to UK HealthCare FMLA administrator at whitney.cunningham@uky.edu or fax to (859) 257-2010. Campus (non-UK HealthCare) employees may submit to their department supervisor or designee.
  • Revision date: 01/05/2016
  • Submit paper form to fax to (859) 257-2010
  • Email form back to whitney.cunningham@uky.edu