Notice Of The Need For Parental Leave Under The Massachusetts Parental Leave Act
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4FROM: _________________________________________________
__________________
Name and Department
Date
RE: Notice of the Need for Parental Leave
This memo is to notify you of my need for leave under the Massachusetts Parental Leave Act,
M.G.L. c. 149, § 105D.
I’m requesting the following dates of leave
to
for this
purpose.
[Start Date]
[End Date]
I have read the MPLA Fact Sheet provided by CES. It is my understanding that I am eligible for
up to 8 weeks of unpaid leave per child under this Act and that I will be reinstated to my job after
my leave. I may choose to use any accrued vacation/sick/personal time during this leave
and will designate this time on my timesheet. It is also my understanding that the
Collaborative for Educational Services will continue my health insurance during my leave.
Signature
Date
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