Mid-Del School District
Employee FMLA Leave Request


Note: * Please fill out all required fields below.

Step 1: Complete the information below and Click Submit.


Date:    10/02/22
Salutation:   
* First Name:   
* Last Name:   
Employee #:   
* Email:   


Note: The email address above should be the email that you use to communicate with Mid-Del School District.

Please be advised that you must follow our usual and customary notice and procedural requirements for requesting leave.