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UT Dallas - Human Resources

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Family Medical Leave (FML)

Family and Medical Leave is a benefit that provides eligible employees up to 12 weeks of unpaid leave in a 12 month period for:

• the birth and care of a newborn child of the employee;
• the placement with the employee of a son or daughter for adoption or foster care;
• to care for a spouse, son, daughter, or parent with a serious health condition;
• to take medical leave when the employee is unable to work because of a serious health condition; or
• for qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on active duty or call to active duty status as a member of the National Guard or Reserves in support of a contingency operation.

How to Apply for Family Medical Leave

You must complete the Request for Family or Medical Leave PDF form, including your supervisor’s signature. Your department keeps the original; you keep a copy and send a copy to HR. Please have the healthcare provider complete the appropriate Certification of Health Care Provider PDF form, depending on whether the request is for you or a family member. The provider’s office can send the completed form to Human Resources, via fax to 972.883.2156, or via email to

Forms Required

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