Peru State College
Crisis Leave Sharing Program
Shared Leave Donation Form
05/04/2020
EMPLOYEE INFORMATION:
NAME: ________________
DEPARTMENT: _______
CLASSIFICATION:
SUPPORT STAFF PROFESSIONAL STAFF FACULTY
INDICATE AMOUNT YOU ARE DONATING BELOW
COMP TIME DAY(S) DONATED:
VACATION DAY(S) DONATED:
SICK DAY(S) DONATED:
*DONATIONS MUST BE MADE IN FULL DAY INCREMENTS
I understand that my leave balance(s) will be decreased immediately by the day(s) I am donating as
noted above, and the day(s) will be credited to the Crisis Leave Sharing Pool to be distributed as
approved by the Crisis Leave Sharing Program Committee.
SIGNATURE: __________________________________________________ DATE: _____________
ONCE PROCESSED AND TRANSFERRED, DONATIONS ARE IRREVOCABLE.
FOR MORE INFORMATION ON THIS PROGRAM, PLEASE REFERENCE APPLICABLE BARGAINING
AGREEMENT (SCEA, NSCPA or NAPE) OR BOARD POLICY (5102, 5103 or 5104)
Return completed form to Human Resources.
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