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Steps for filing:

  1. Complete the Family and Medical Leave Request. Provide this form to the supervisor for approval, and forward to Angie Judish in the Office of Human Resources when complete.
  2. Contact the Office of Human Resources regarding the Physician’s Certification
    Form.  These forms are available on the Human Resources website at the following links.  The employer section will be completed in the Office of Human Resources.  The form will be returned to the employee via email or U. S. Mail, whichever method is preferred.

  3. Provide the appropriate Physician’s Certification Form to the attending physician for completion.  This form may be returned to the employee to be sent to Angie Judish in the Office of Human Resources or the form may be sent via fax (931) 221-6345, email (, or U. S. Mail (APSU, P. O. Box 4507, Clarksville, TN  37044), whichever method is preferred.  The original copy is not required.
  4. The documents will be reviewed according to the information available on the Department of Labor website at, and in our APSU Personnel Policy at
  5. The notification will be mailed to the employee’s home address regarding approval or disapproval of the request for FMLA.
  6. Any leave taken for the designated FMLA reason should be reported under “FMLA Leave” on the leave report.  Authorization for the leave should be kept on file in the department based on the normal departmental procedure for leave approval.