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Sample Leave Letter

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					                       SAMPLE: MATERNITY LEAVE LETTER
[Insert Date]



Joseph Casey, Superintendent of Schools
Melrose Public Schools
360 Lynn Fells Parkway
Melrose, MA 02176

Dear Superintendent Casey:

I am writing to inform you that my maternity leave will be effective on or around (insert date). A copy of
my physician’s letter attesting to that determination is attached. It is my current intention to take my
maternity leave and FMLA leave provided by the contract and statute, subject to the safe delivery of my
child.

IF YOU KNOW THAT YOU INTEND TO TAKE AN UNPAID CHILD REARING LEAVE, INCLUDE
YOUR PLANS, I.E.:

             •     THE BALANCE OF THE SCHOOL YEAR,
             •     THE NEXT SCHOOL YEAR,
             •     THE FIRST HALF OF THE UPCOMING SCHOOL YEAR

AND THEN ADD A SENTENCE STATING: I WILL FURTHER CONFIRM MY CHILDREARING
LEAVE PLANS SUBSEQUENT TO THE BIRTH OF MY CHILD.

I understand that my FMLA leave will run concurrently with my period of disability, that it will extend
four (4) weeks beyond the statutory period provided for childbirth and recovery therefrom referenced in
the MEA contract and that during the twelve (12) week time period the Melrose School District will
continue to pay its share of my health insurance cost. I also understand that, should complications arise
during my period of childbirth and recovery therefrom, my disability period may be further extended into
that FMLA time period and beyond, depending on the nature of the extended disability.

IF YOU KNOW THAT YOU ARE GOING TO TAKE THE UNPAID CHILDREARING LEAVE AND
KNOW WHAT YOUR INSURANCE PLANS ARE-I.E. COBRA, MENTION THAT IN THE CLOSING
PARAGRAPH.

Sincerely,



Name
Position, School

cc.     Your building principal
        Gregory Zammuto, Business Manager

Enc:    Letter from your doctor