Forms → Staff → Benefits → Request for Leave under the Families First Coronavirus Response Act
Form number: 430-1C
Audience: MCPS Staff
Last revised: April 2020
To complete this form using the interactive features and electronic signature:
Save the form to your computer, close the PDF of the form that was opened from the MCPS website, and reopen the form from where you saved it on your computer.
Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat