PDF
… include age if child):
Date illness/injury began: _______________________
Estimate of number of hours requested: ________
Anticipated duration:
Date all paid leave will be/was exhausted
Shared leave will only be granted for serious, extreme, or life-threatening illnesses, injuries, impairments or physical or
mental conditions which have caused, or are…
https://www.wichita.edu/services/humanresources/Total_Rewards/docs/Shared_Leave_Request.pdf