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MEMORANDUM
TO: GRCC Employee
FROM: Human Resources
SUBJECT: Family Medical Leave Act Information
Attached is information on the Family and Medical Leave Act of 1993. Employees are eligible if they
have worked for Grand Rapids Community College at least 12 months, and have worked at least 1,250
hours over the past 12 months. Various medical conditions are appropriate for Family and Medical
Leave, such as continuing treatment for chronic or long‐term medical conditions.
If FMLA leave is appropriate for you, please complete the Family and Medical Leave Request form
before you begin your leave. This form needs to be complete with your signature and the signature of
your supervisor. Return to your Human Resource Generalist upon completion.
Also, complete the top portion of the front page of the Certification of Health Care Provider form.
Include the employee’s name and department, or if applicable, the patient’s name and relationship to
the employee. The attending physician must complete the remainder of the form. Once this form is
completed by your physician, please return to your Human Resource Generalist. Your physician may fax
the form to Human Resources.
Attached you will find the GRCC policy on Family and Medical Leave, Information on FMLA, the Family
and Medical Leave Request form, and the Certification of Health Care Provider form.
If you should have any questions, please call (616) 234‐3972.
Human Resources
Phone: (616) 234‐9372
Fax: (616)234‐3907
hr@grcc.edu