Shared Leave Donation Form

Name of the person whom you are making a donation to:

Recipient's Department:

Donating Hours:

Which leave hours would you like to donate?
Vacation (Unclassified Board of Regents may not donate vacation)
Sick Leave

How many hours would you like to donate?

I understand that my donation is voluntary and confidential. I understand that my leave balance will be decreased by the amount contributed. I understand this donation may affect the payout of sick leave upon retirement or the payout of annual leave upon any termination. I understand that the employee I'm donating to must be approved to receive Shared Leave.

By submitting this donation you are certifying that you are the person named on the donation form. Further that any and all information contained on the donation form is complete and accurate. Any material misrepresentation or inaccuracies may result in denial of eligibility or other sanctions.