APPLICATION FOR PRE-RETIREMENT SUMMER ASSIGNMENT OPTION
TO: Provost and Vice-President for Academic Affairs
FROM: ________________________________________
DATE: ________________________________________
(Please print or type name)
I wish to apply for a pre-retirement summer session assignment (per Article 6.9 of the applicable collective bargaining
agreement (Agreement) for the summers of ________ and ______.
I understand that with the approval of this application, I am not eligible for my department’s rotational summer session
assignments for the two summer sessions covered by my pre-retirement summer session assignment and for the two summer
sessions immediately following my pre-retirement summer session assignment. After this period, if I am still employed in
Unit A, my name shall be added to the bottom of my department’s summer session rotation plan. I understand that my
signature below indicates my acceptance of all of the provisions of Article 6.9 of the Agreement with regard to this
assignment.
____________________________________
Signature
******************************************************************************
Having verified that you
Year
Year ___
-----------------------------------
Yes No Yes No have completed 15 years of Unit A service at the University.
Yes No Yes No do not currently have an annual appointment at the University of more than 10 months.
Yes No Yes No are not on retraining leave or leave without salary.
Yes No Yes No have not previously received a pre-retirement summer session appointment.
Yes No Yes No have declared a firm retirement date.
I Approve Do Not Approve your application for summer
.
________
Provost/VPAA Date
I Approve Do Not Approve your application for summer
.
________
Provost/VPAA Date
Reasons:
cc: Dean & Dept. Chair
