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Family or Medical Leave Request

Document Number:  ERD-10110

Description:  This form may be used to assist in establishing leave entitlement under Wisconsin's Family and Medical Leave Law.

Comments:  This form may be reproduced by employers.

Content Contact:  Equal Rights Information

Document Attachment:  ERD-10110 (pdf/12 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.