This government document is issued by University of Nebraska for use in Nebraska
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https://www.google.com/url?client=internal-element-cse&cx=013429021325017991006:1mgv5ajsxfq&q=https://nebraska.edu/-/media/unca/docs/offices-and-policies/documents/forms/major-disaster-leave-request-form.pdf&sa=U&ved=2ahUKEwih78KgjpeIAxVzgv0HHYraJls4FBAWegQIBRAB&usg=AOvVaw3bpsnxOZBWADEDxAEN0AIB&arm=e