W
INTHROP UNIVERSITY
Leave Transfer Program
Leave Donation Request Form
Name
College / Division
Winthrop ID
Department
I request that the amount of hours for the type(s) of leave listed below be transferred from my account to
the University’s leave transfer pool. I understand that once my leave credits have been transferred to the
pool account, such credits will not be restored or returned to my account.
Hours of Annual Leave
Hours of Sick Leave
I understand that I may donate no more than one-half (½) of the sick or annual leave earned within a calendar
year to the appropriate pool leave account for that calendar year, and that I must retain a minimum of 15 days
of sick leave. I also understand that I may not specify to whom my donated leave may be awarded.
Employee Signature Date
Request Form must be received in Human Resources prior to December 13th.
For HR Use Only
Leave
Type
Available
Balance
(hours)
(-)
Required
Min Balance
(-)
Max Donation
(Annual Accrual / 2)
Max
Available to
Transfer
Hourly
Rate
Donation Value
ANNUAL
n/a
SICK
15 days
hours
Update items: Annual Accrual (Leave Category: __ __ ) = Monthly Accrual Rate [ ] x 12 = _________
Revised 11/25/2019