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Forms for Leaves and Absences
Most of the forms below are PDF files. If you encounter any problems viewing PDFs on your computer, you may need to install the free Adobe Reader software.
PLEASE NOTE: The “Application For Age 26 Young Adult Coverage” form is no longer required by the UFT Welfare Fund. Members wishing to add a dependent under age 26 to their Welfare Fund coverage at no cost should use the Welfare Fund’s online Update Your Information (Change of Status) form.
Pedagogues and paraprofessionals use this form to apply for a retirement leave of absence. For every two days in the employee’s sick bank, one day of terminal leave is granted. The form must be filed 30 days in advance of the leave. The leave can only cover up to one term and cannot extend from one school term to another. See page 2 for guidelines. In order to go on a terminal leave, paraprofessionals must be members of the Teachers' Retirement System.
All pedagogues and paraprofessionals may use this form to donate sick time to a colleague. The recipient receives one day for every two days donated. Sick leave transfer rules are on page 2 of the form.
Must be filed along with a FMLA request.
For pedagogues and administrative staff. You must provide acceptable certification by a physician or other health care provider for your own serious health condition or the serious health condition of a covered family member within fifteen (15) calendar days of the request for leave, where practicable. Please see Personnel Memorandum No. 54, 1995-1996 for further information.
All pedagogical personnel may apply for a medical leave of absence without pay only when they have exhausted all of their Cumulative Absence Reserve (CAR) days. This application must be completed, signed and submitted to HR Connect for approval. Documentation and/or statement of particulars must be submitted with the OP 160 form. Rules and instructions are on page 2.
This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules and instructions are on page 2.
All pedagogues, paraprofessionals and administrative staff use this form to request time off with pay and no loss of CAR time for the circumstances listed on page 2 (death in the family, jury duty, graduation, religious observance, etc.). OP 201 is also used to request a day off without pay in certain circumstances.
Upon an employee’s return from a leave of absence without pay, the payroll secretary must submit an OP 255 form to the Bureau of Salary Differentials and Status.
Upon resignation, termination or retirement, pedagogues are entitled to receive half of their sick leave balance (up to 100 days).
This application is to be utilized for initial requests for leaves of absence as well as requests for extensions.
Administrative staff may apply for a medical leave of absence without pay only when they have exhausted all sick leave and/or annual leave days. This application must be completed, signed and submitted to HR Connect for approval. Documentation and/or statement of particulars must be submitted with the form.