UCP Bereavement Leave Request Form

UCP is so sorry to hear of the loss of your loved one and would like to send you our condolences during this trying time.

As per our Team Member Handbook, if the loved one you lost was a member of your immediate family, UCP employees can be granted a period of up to three (3) days paid and up to two (2) additional unpaid days of Bereavement Leave to attend related obligations and commitments. These days may be taken on a consecutive OR intermittent basis. Bereavement Leave must be used within three (3) months of the individual’s death.

Please provide the information requested below:

1. Your full legal name:

2. Your email address:  

3. The person’s first and last name:

4. Your relationship with the individual; please check all that are applicable. If none of them apply, you will not qualify for Bereavement Leave.

Select all that apply

5. Their date of death:

6. Please list all dates for which you are requesting leave:

7. You must provide verification of the death. Please include one of the following items: death certificate, memorial service bulletin, obituary, or other document. Any item you provide must include the individual’s full name and their date of death OR the date of the service. Allowed file extensions are jpg, jpeg, jpe, gif, png, pdf. Motion photos and HEIC files will NOT upload. Please take a static screenshot of motion photos or manually save as one of the supported file types.

8. If the dates you have requested off are in the future, notify your manager if you haven’t done so already.

After completing all the steps above, please scroll down to sign and submit the form.