Sick Leave Donation Form
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1
2SICK LEAVE DONATION AGREEMENT
I,
,
, employed by
Donating Employee's Name
Banner ID
wish to donate
days/hours of sick leave to
Institution
,
Employee To Whom Donating Leave
Banner ID
I understand the following:
(1) I must currently have 20 days of accrued sick leave.*
(Example: 20 x 7.5 accrual rate = 150.0)
(2) I must agree to donate a minimum of 5 days of accrued sick leave.* ( Example: 5 x 7.5 =37.5)
(3) I may not donate more than one - half of my sick leave balance at the time of transfer.
(Example: ½ x 150.0 hours = 75.0 hours)
(4) I may not donate more than 90 days of accrued sick leave during my employment with this
institut ion/school.
(5) I agree that any unused sick leave which I have donated to the employee stated above will be
transferred to the Sick Leave Bank.
*The accrual rate is based on my percentage of employment.
I am donating this leave of my own free will and have not been unduly influenced in any manner
to make this contribution.
________________________________
____________________
Donor's Signature
Date
________________________________
____________________
Witness
Date
________________________________
____________________
Witness
Date
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Parent category: Letters