Forms\Banked Use
PASADENA AREA COMMUNITY COLLEGE DISTRICT
APPLICATION TO USE BANKED HOURS
Semester Year
Name Social Security Number - -
Division Extension
This “Application To Use Banked Hours” must be submitted one semester in advance of proposed
use, except when used in conjunction with a sabbatical, in which case the application must be
submitted when a sabbatical leave is approved.
PLAN
(check one)
_____ I wish to use my banked hours to supplement my assignment. My assignment will
be reduced to _____% for the (check one):
________ semester 20 ____. Academic year 20 ____ – 20 ____.
_____ I wish to use my banked hours to take banked leave during the (check one):
________ semester 20 ____. Academic year 20 ____ – 20 ____.
_____ I wish to use my banked hours to fill out my sabbatical leave.
_____ Other (please indicate plan): __________________________________________
_________________________________________________________________
I request a pay-off of my banked hours:
_____ All banked hours
_____ Partial payoff (enter FTE to be paid) Amount of FTE: ________
(payoff on the basis of “first in, first out)
Applicant’s signature Date
(Division Use)
Staffing/Program Needs
Appropriate part-time staff is available _____ Yes _____ No
_____n/a
Program needs will be met during absence _____ Yes _____ No
APPROVALS:
___ Approved ___ Denied
Division Dean Date
___ Approved ___ Denied
Asst. Sup./ Vice President, Instruction Date
