University of Toledo/AAUP

Sick Leave Donation Form

Name of Donor Employee:

Rocket ID Number:

Rank:

Department:

Office Telephone: Home Telephone:

Preferred E-Mail:

I hereby authorize the UT Payroll Department to deduct _____ hours (at least 8)

from my accrued sick leave to be used by the UT-AAUP Leave Bank Committee’s designee.

Signature: ___________________________________ Date: _______________

Please return the completed form to the UT-AAUP Office, UH 5150 A-C, MS 961.

Thank you.

Please print and mail to UT-AAUP, MS 961, UH 5150 A-C or fax to 419.530.7271.