Berwyn South School District 100

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Hello D100 Staff
The following is the procedure when requesting Family Medical Leave ( FMLA).
Please complete all of the steps below.
  1. Log on to FMLA Questionnaire Form and complete the google form.
  2. Below are FMLA Documents for your physician to complete with medical information. Download the one pertinent to your situation.
  3. Send the completed document with the original physician's signature to James Calabrese, Director of Staff & Student Services at LaVergne Education Center., 3401 Gunderson Ave. Berwyn, IL. 60402.
  4. After all the paperwork has been submitted and reviewed you will receive a Letter of Approval or Denial for your FMLA request medical leave via the US. mail and email from
  5. If you have any questions during this process please contact Jenny Hosty via email at or by phone at 708.303.4008.