Use this page to access forms necessary to be granted long-term leave by the district. Reasons for such leaves include: health reasons for you, a spouse, for family member; birth or adoption leave; military leave; or leave to pursue further training/education related to your job.

If your leave is medically related, you must familiarize yourself with your rights under the Family and Medical Leave Act (FMLA) of 1993. And you must have signed certification of a health care provider. Please use the following two forms:

Your Rights Under the FMLA
Health Care Provider Certification for FMLA

For the purposes of any leave, you will need to complete the district's own leave form. Please access it via the link below:

Leave of Absence District Form

Family Medical Leave guarantees a position for up to 12 weeks and takes care of your health benefits. The district requires the above forms before you can be put on leave. If the date of your return changes, please have a doctor document this and return it to the district.

Regarding your pay, the district uses your accrued paid leave for the absence up to your available balance unless you provide written notification to Human Resources prior to the beginning of the leave to use unpaid leave. Additional time on leave is unpaid.

Extended Sick Form - Classifed Employees
Licensed Sick Bank Application

More questions? Contact:

Judy Steinbaugh
BVSD - Human Resources
6500 Arapahoe Road
Boulder, CO 80303
Personnel Technician
303-447-5032
Fax 303-447-5098

Medical/Dental Insurance
 
Medical and dental insurance may be continued at your expense during your leave of absence. If you are on Family Medical Leave Act (FMLA), the district may continue your coverage, but you must still pay for your dependents. Payments must be received by the Division of Human Resources by the first of each month. Premium payments received later than 30 days will not be accepted and coverage will be terminated. Coverage begins again after you return to work and complete necessary paperwork. Reminders are not sent.

Remember: You must re-enroll onto the policy when you return to work. If you do not re-enroll, coverage will not begin until the first of the following month in which you re-enroll. Contact us when you return to work!

• If you want continuous coverage during your absence, leave checks with Human Resources. You may choose medical and dental, or medical only. Check with us for prices.
• If you do NOT pay for your insurance, it will be terminated unless you are on FMLA. (After FMLA ends, you may continue coverage at your expense.) If you return to work within 12 months, your coverage will begin on the first day of employment...IF you complete the paperwork in the correct timeframe. If you return to work after 12 months, your coverage will be effective on the 31st day of work...IF you complete the paperwork in the correct timeframe.

District Life Insurance/Long Term Disability Insurance

• While an employee of the district, you have a life insurance policy of $20,000. This is continued during your leave at a cost of $3.10.
• Employees of the district also have Long Term Disability coverage at no cost. This stops when your leave begins; however, it starts again when you return to work.

 
PERA - Survivor Insurance

• If you wish to continue PERA life insurance during your leave, contact Payroll. If you let this coverage cease, you must reapply during PERA's open enrollment.