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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/13 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.