NIU HRS - Request for Paid Administrative Leave for COVID-19 Related Reasons

First Name *

Last Name *

Employee ID *

Department *

NIU Email Address *

COVID-19 Vaccine Information

Only employees who are fully vaccinated against COVID-19 or have an approved medical or religious exemption are eligible for this benefit. Fully vaccinated against COVID-19 means two weeks have passed since receiving the primary series of a COVID-19 vaccine (1 dose of Johnson & Johnson, or two doses of Pfizer or Moderna).

Please upload proof of vaccination here. If you need to upload multiple files, please make sure the files are compressed into a single ZIP file before uploading. *

Type of Request *

I am currently or was recently in required isolation because of a confirmed positive COVID-19 diagnosis from a laboratory-based test.

I am currently or was recently unable to work because my child was required to be excluded from school or preschool because of a confirmed positive COVID-19 diagnosis from a laboratory-based test or because of COVID-19 symptoms if the school requires isolation for that reason.