FFCRA Reporting

Emergency Paid Sick Leave under FFCRA Request

Please complete the form below if you are not approved/or unable to work remotely. FFCRA is for positive CoVID employees only for the initial quarantine beginning from start of symptoms/positive test result up to 10 days, if needed.
Have you file for FFCRA in 21/22 school year? *

Yes No
Reason for FFCRA *

Employee positive CoVID-19 test result (household members do not qualify)
Who are you requesting FFCRA for? *

Yourself/Employee Household Member
Name *

First Name Last Name
Employee ID *
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Position/Title *
Campus/Department *
Principal/Supervisor *
First Day out due to CoVID *

Month Day Year
Date
FFCRA Proof *

CoVID results
Cancel of
Should be Empty:

Emergency Paid Sick Leave under FFCRA Request