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705 Broad St. Box 90496
Durham, NC 27705
Phone: (919) 684-5600
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Designation Notice (Family and Medical Leave Act) (Form 95)

The following Family Medical Leave form should be maintained in a confidential file with the employee's department. Please do not submit to Corporate Payroll or HR.

Form Name Format
Designation Notice (Family and Medical Leave Act) (Form 95) PDF
* Some Duke HR forms may require you to list your Duke Unique ID.  If you do not know or are unsure of your Duke Unique ID, you can look it up here.

** Some forms available on this web site are in Adobe Portable Document Format (PDF).  You will need Adobe Acrobat Reader to view and print these forms.