FMLA -Family Medical Leave Act - Okaloosa County School District 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and the last four digits of your Social Security number in the designated fields. This information is crucial for identification purposes.
3. Fill in your work location, position, and years employed by the Okaloosa School District. This helps establish your eligibility for FMLA leave.
4. Provide details about the patient, including their name and relationship to you (spouse, child, or parent). If different from the employee, ensure accuracy.
5. Indicate whether the patient's condition qualifies as a 'serious health condition' by checking the appropriate category on the form.
6. Describe medical facts supporting your certification. Include dates of onset and expected duration of incapacity if applicable.
7. Complete sections regarding treatment requirements and any necessary intermittent leave. Be specific about how often treatments will occur.
8. Finally, sign and date the form at the bottom to validate your request for leave.

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