SICK LEAVE DONATION
Leave and Absentee Report Forms must be submitted to Payroll within a week of time taken.
Please indicate name of specific individual you are donating to:
I wish to donate sick leave to
(Print name of employee to whom you wish to donate sick leave)
Your Name (please print):
Your NSU ID #: Phone Ext.:
Number of sick leave hours you wish to donate: Department:
Your Signature: Date:
[University School employees must fax copy of form to Shari Clifford at 1629 ]
This Area is for Benefits Administration Use Only
Date Request Received: Approved Denied
Approved/Denied by: Date:
Comments:
Number of Sick Leave hours to be decreased on PEAEMPL:
Entered in Banner by: Date:
DISTRIBUTION: Send original to OHR-Benefits, department and employee maintain a copy for their records