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Leaves of Absence

Generally, employees may be granted full or partial leaves of absence with and without pay depending on the circumstances and duration of the leave request. Eligibility guidelines are subject to appropriate Collective Bargaining Agreements (CBAs), specific policies, applicable legal agreements, and current state and federal legislation.

Request for Medically Related Leave

Employees requesting an extended medical related leave of absence, (off work full time for more than 3 to 5 workdays) or planning a CSU Parental Leave, must complete the Request for Medically Related Leave application and appropriate medical certification form.

Request for Leave (required for all leaves) ADOBE SIGN

Choose the appropriate medical certification below that corresponds to your leave request type. Download the certification and provide it to your healthcare provider to complete and return to Cal Poly Human Resources, Disability Leaves fax 805-756-5483, or

  • Medical Leave for the care of a family member, or an employee, includes partenal leave requests (nonpregnancy disability related):

    Medical Certification PDF
  • Pregnancy Disability leave and/or accomodations (cannot work due to pregnancy):

    Medical Certification Pregnancy Related PDF
  • Cal Poly Human Resources will review your request and provide you with additional information regarding your need for leave within 5 business days. Please email for questions.