Page 1 of 1 Faculty Affairs Office, Bell Tower West
Revised: 02/03/2009
CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS
APPLICATION FOR FACULTY EARLY RETIREMENT PROGRAM (FERP)
(As provided by Article 29 of the Faculty Bargaining Agreement)
Name of Applicant
Program College
Academic Year in Which FERP is to Begin
(Participation must commence at the beginning of an academic year. In addition to submitting this form to CSUCI,
participants must submit a “Service Retirement Election Application” to the Public Employees’ Retirement System
(PERS) at 400 P Street, Sacramento, CA, no more than 90 days prior to their retirement date and be granted a Service
Retirement effective on or before the first day of the academic year in which FERP participation will commence.)
CSUCI Separation Date: PERS Retirement Date:
(Must be at least 1 day after separation date)
Select one of the following work schedules:
Full-time each Fall semester for 50% of annual salary
Full-time each Spring semester for 50% of annual salary
Half-time (50%) both Fall and Spring semesters for 50% of annual salary
Other (Specify):
I recognize that this request, if granted, will be pursuant to Article 29 of the Faculty Bargaining Agreement. I have read
the requirements of Article 29 concerning eligibility and believe that I am eligible to participate in the program. I
understand that once I have started working under the FERP, I may not return to full-time employment. If my request is
granted, I agree to abide by the terms and conditions of Article 29 of the Faculty Bargaining Agreement. (Copy
attached)
Faculty may retain up to forty-eight (48) hours of their accumulated sick leave credit for use during participation in
FERP. Please indicate below the number of hours of sick leave credit you wish to retain (from 0 to 48 hours).
I wish to retain
hours of sick leave credit.
_____________________________________________________ _____________________________
(Signature of applicant) (Date of application)
(Forward to Program Chair)
______________________________________________________ _____________________________
(Signature of Program Chair) (Date)
(Forward to Dean of the Faculty)
______________________________________________________ _____________________________
(Signature of Dean of the Faculty) (Date)
(Forward to Provost & Vice President for Academic Affairs)
I have reviewed this application in accordance with Article 29 of the Faculty Bargaining Agreement. FERP
participation is hereby approved for _____ years beginning with the ________-________ academic year and
ending with the ________-________ academic year.
_____________________________________________________ _____________________________
(Signature of Provost & Vice President for Academic Affairs) (Date)
