How to Fill Out and Submit MCPS Form 430-1: Leave Request

MCPS Form 430-1 is the Montgomery County Public Schools leave request you file when you need five or more consecutive duty days off for any reason other than annual or personal leave. Fill in your personal information, dates, and leave type across the form’s four sections, attach the documentation your leave category requires, hand the package to your principal or supervisor for signature, and route it to the Employee and Retiree Service Center (ERSC) for final authorization and payroll processing.

Make Sure 430-1 Is the Right Form

MCPS splits leave requests between two forms, and picking the wrong one sends your paperwork back.

Use Form 430-1A for annual or personal leave of any length, bereavement of five days or fewer for immediate family (or two days for other eligible family members), and any other leave type lasting four duty days or fewer. It goes only to your principal or supervisor.
Use Form 430-1 for five or more duty days of any leave type except annual or personal leave. It needs supervisor sign-off and ERSC authorization.

Annual and personal leave never run on the 430-1, no matter how long the absence.¹

Download the Current Version

Pull the form from the MCPS forms website. The current revision is dated May 2025.² Older copies floating around in school office folders may be out of date. Use the fresh PDF each time.

Filling Out the Four Sections

Section I: Read Before You Sign Anything

Section I looks like boilerplate but contains the warning that catches people out. If your leave will exceed 60 duty days and you receive health or life insurance through MCPS, you have a choice to make about coverage. To discontinue, log into Hub+ and select “Waive All Benefits Coverage” under the Report a Life Event tile. Do nothing and MCPS treats that as a request to continue coverage, which makes you liable for premiums that run roughly 10 to 20 times your normal biweekly benefit deductions. Flexible spending accounts may also be cancelled for leaves longer than 60 duty days.²

Section I also reminds Sick Leave Bank members to contact their union about a grant and tells employees who move during a leave to update their address and phone number through Hub+.

Section II: Personal Information

Enter your last name, first name, and middle initial; your employee ID number; your school or location name; your job title; and your home and cell phone numbers. Write the full location name, not a numeric code.

Section III: Leave Dates

Fill in the total number of duty days you are requesting, the start and end dates of the leave, and the last full day you worked (or will work) before the absence begins. Two yes-or-no questions ask whether this extends a previous leave and whether you are requesting intermittent leave. Then check the box indicating whether the leave falls between 5 and 60 duty days or exceeds 60 duty days. That distinction matters because leaves over 60 days put you into long-term leave status, with different benefits rules.

Section IV: Type of Leave

Check the single category that applies. The checklist covers:²

Academic Study, paid at either 50 percent or 60 percent of salary.
Bereavement.
Child Care, covering maternity, paternity, and adoption-related absences.
Civil, Juror, or Witness.
Exchange or Overseas Teaching.
Illness in Family.
Intermittent, for non-consecutive days tied to a qualifying ongoing condition.
Long-Term Family or Long-Term Personal, available to MCEA members only.
Military Service and Military Training, with training leave capped at 15 days.
Personal Illness.
Political Activity, to run for or serve in elected office.
Professional Improvement, with two tiers based on one or three years of service.
Workers’ Compensation, which requires the date of the workplace accident.
Unusual or Imperative, an unpaid category for circumstances that fit nothing else. A separate option exists for study through MCPS University Partnerships.

Some choices have sub-options. Academic Study requires you to mark 50 percent or 60 percent. Professional Improvement asks whether you have one or three years of service. Workers’ Compensation needs the accident date.

Attach the Right Documentation

Form 430-1 requests require supporting paperwork, and missing attachments are the most common reason forms come back. What you need depends on the leave type.

For personal illness or illness in the family of five or more days, you or your physician must complete MCPS Form 440-35, the Certification of Physician or Health Care Provider. Email the completed 440-35 directly to ERSC rather than attaching it to the paper 430-1. The certification confirms the necessity of the absence and an expected return date; it does not need to disclose a specific diagnosis.¹
For bereavement, the form itself asks for the relationship and date of death. Your union contract defines which relatives qualify and how many days you receive.
For military service or training, provide a copy of your orders or a written statement from your commanding officer.
For professional improvement, attach a conference agenda, registration confirmation, or letter from the sponsoring organization.
For workers’ compensation, include copies of the incident report and any claim documentation.

Check that every required document is attached and every field on the 430-1 is legible before you hand it off.

Submitting the Form

There is no online portal for Form 430-1. The leave request is a paper-and-signature process routed through your supervisor to ERSC, even though Hub+ handles benefits changes and address updates during a leave.

Hand the completed packet to your principal or direct supervisor for review and signature. Discuss your plans with them first; the form’s own instructions call for that conversation up front.²
Your supervisor evaluates the request against staffing needs and your available leave balance. You cannot request more leave than you have available, and a request for leave without pay may be denied.¹
Once signed, the form and attachments go to ERSC for final authorization and entry into the payroll system.
If your leave involves personal illness or family illness of five or more days, separately email the completed Form 440-35 to ERSC.

What Changes at 60 Days

Any leave that exceeds 60 duty days puts you into long-term leave status.³ If you keep health and life insurance during an unpaid long-term leave, you pay the full premium cost yourself at roughly 10 to 20 times your normal biweekly deduction.² Current premium rates are on the ERSC website. To discontinue, log into Hub+ by the end of the month and select “Waive All Benefits Coverage” under the Report a Life Event tile. Coverage ends on the first day of the following month.

Unpaid leave classified as Unusual or Imperative for Study does not count as a year of service for salary-step or seniority purposes, and benefits during that time are charged at full cost.⁴ If you are returning from academic leave with a service obligation and do not complete the required period, you repay the salary MCPS paid you during the leave plus the employer’s share of benefit and retirement contributions.

If Your Request Is Denied

A supervisor who denies a leave request should provide a reason. The common grounds are insufficient leave balance, inadequate staffing coverage, or missing documentation. For personal leave under the MCEA contract, a request can only be denied if the supervisor determines that adequate provisions for continuing the school program are insufficient.⁵

If you believe the denial is wrong, your union’s grievance procedure is the standard path. Raise the issue with your immediate supervisor first, then escalate in writing through the levels outlined in your collective bargaining agreement. Keep copies of every form you submitted and any written denial you received. For denials connected to pregnancy, a disability, or a religious observance, federal anti-discrimination protections may also apply. The Pregnant Workers Fairness Act prohibits employers from forcing leave when a reasonable accommodation would let you keep working.⁶

1
Montgomery County Public Schools. Employee Leave Information
2
Montgomery County Public Schools. MCPS Form 430-1 Leave Request
3
Montgomery County Public Schools. Long-term Leave
4
Montgomery County Public Schools. Academic Leave FAQ
5
Montgomery County Public Schools. MCEA Negotiated Agreement 2023-2027
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U.S. Equal Employment Opportunity Commission. Pregnancy Discrimination and Pregnancy-Related Disability Discrimination