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FMLA Forms

Completed forms can be submitted either:

  1. Mailing completed forms to: City of Waterbury, Education Personnel Office, 236 Grand Street, 3rd Floor, Waterbury, CT 06702
  2. Faxing completed forms to: 203-574-6703 or
  3. Emailing completed forms to: FMLAinquiry@waterbury.k12.ct.us.

Please be sure these completed form are returned as soon as possible or provide a reasonable explanation for the delay.

Fact Sheet

City FMLA Policy

FMLA Doctor Certification (Certified & Non-Certified Staff)

FMLA Doctor Certification for Family Members

Fitness for Duty Certification