Pennsylvania maternity absence: Fill out & sign online

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Click ‘Get Form’ to open the Pennsylvania Maternity Absence form in the editor.
Begin by filling out the Member Information section. Enter your name, address, Social Security number, and contact details. Ensure all information is accurate as it is provided through your employer.
In the Leave Information section, provide details about your maternity leave. Include the employer's name where the leave occurred, the school year of your leave, and the effective date of resignation if applicable.
Next, move to the Child Information section. Enter each child's name and date of birth. Remember to indicate if any child was adopted; however, note that credit cannot be obtained for leaves taken due to adoption.
Finally, complete the Member Certification by signing and dating the form. This signature confirms your request for service credit purchase related to your maternity leave.

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