Adoption Leave Request Form

In order to process your request to take Adoption Leave, the following information is required. Please complete and return this form enclosing any relevant documents or by emailing all relevant documents to ‘Human Resources Administration Team’

You must complete this form to notify the University of your intention to take adoption leave:

  • within 7 days of being notified by the adoption agency that you have been matched with a child for adoption (unless this is not reasonable practicable), for adoptions from within the UK;
  • within 28 days of receiving official notification from the relevant domestic authority that you are eligible to adopt, for adoptions from overseas.

Name: / Staff No:
Faculty/Unit: / Are you employed Full Time?
If you are employed Part Time please give details? / Yes / No
Hours per week / Days per week
Are you also an Associate Lecturer? / Yes / No
A. Please complete this section if you are adopting from within the UK
I confirm that the ‘matching’ certificate or a letter from the adoption agency is (please check as appropriate) / Already submitted / Attached / To follow
Please answer the following questions:
On what date is the child expected to be placed with you? / Date:
On what date do you intend to start your adoption leave? (Please note: this can be the date of the child’s placement and will then vary should the placement be earlier or later than expected, or a fixed predetermined date which is no more than 14 days before the expected date of placement). / Date:
B. Please complete this section if you are adopting from overseas
I confirm that the official notification from the relevant domestic authority confirming that I am eligible to adopt is (please check as appropriate) / Already submitted / Attached / To follow
Please note: you are also required to provide further evidence of the date of entry (e.g. entry clearance documents) within 28 days of the child entering the country.
Please answer the following questions:
On what date did you receive official notification from the relevant domestic authority that you are eligible to adopt? / Date:
On what date is the child expected to enter into the country? / Date:
On what date do you intend to start your adoption leave? (Please note: you are required to give at least 28 days notice of the actual date you want the adoption leave to start, and this can be from the date the child enters Great Britain, or from a fixed predetermined date no later than 28 days after the date of entry). / Date:
C. Please complete this section in all instances
Is it your intention at this stage to return to work for at least 3 months after adoption leave? (You are able to change your mind). / Yes / No
*What is your likely return to work date? / Date:

*Note that you do not have to provide this information but it would assist with workload planning.

Please note the following points:

  • If you plan to take annual leave at the end of your adoption leave you must discuss and agree this with your line manager.
  • Only one parent can take adoption leave (a partner may qualify for paternity leave), and therefore by completing this form you declare that you will not be taking paternity leave (if appropriate).
  • Adoption leave is not available in circumstances where a child is not newly matched for adoption (e.g. when a step-parent is adopting a partner’s children).

Name / Date
Signature

If you have any questions you would like to ask in relation to your adoption leave please contact the HR Support Team on‘’

Human Resources HRF081

April 2016

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