LEAVE DONATION AUTHORIZATION
SECTION I: To be completed by the donor
In accordance with the Leave Donation Policy, I donate:
______ hours of my annual leave
______ hours of my sick leave
I understand that the above amount(s) of donated leave will be deducted from my accrued annual, and/or sick leave
balance(s) and will not be available for my use during employment or retirement. This donation is irrevocable.
Printed Name of Donor Work Phone #
Signature of Donor Date
This donation will not be processed without appropriate signatures
SECTION II: To be completed by Human Resources or other designated individual.
Employee ID # Date Processed Processed By Leave Balance(s) AFTER Donation
ANNUAL
SICK
Signature of Leave Administrator Date
Signature of Director of Human Resources Date
