Revised: June 3, 2015
Voluntary Shared Leave Form
Shared Sick and/or Vacation Leave
I would like to donate sick leave and/or vacation hours for my:
Colleague at Sandhills Community College.
My family member:
_______________________________________ located at
(Name of Colleague/Family Member receiving leave)
(if applicable, work location of family member)
Please list the hours (in the appropriate spaces below) that you would like to donate to your colleague
or *family member named above.
Please keep in mind that when donating sick leave, you must keep a balance of at least 40 hours in your
account. When donating vacation leave, you must keep one-half of your yearly accrual in your account. Also,
any unused shared leave will be returned to donor’s account.
*When donating shared leave, the policy (N.C. GS 115D-25.3) allows any employee of a community college to
share leave voluntarily with an immediate family member who is employed at a community college, public
school, or State agency. An immediate family member is defined as “spouse, parent, child, brother, sister,
grandparent, or grandchild. The term includes the step, half, and in-law relationships.”
Total Hours of Leave You are Donating
Sick Leave: ____________________
Vacation Leave: ________________
Your Printed Name: ______________________________________________________
Your Signature: __________________________________________________________
Date: _______________________________
Date Received: ________________________ Total Hours Donated: ___________
Total sick leave hours recorded: _____ Total vacation leave hours recorded: _____
Sick leave hours used by employee: _____ Vacation hours used by employee: _____
Shared leave hours donated to family member: _______
Shared leave used by employee: _______
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