To:

Payroll

From:

________________________________________

(Print name of donating employee)

Subject:

Request to transfer annual vacation and/or sick leave

leave and/or _______ HOURS of my sick leave to:

I wish to donate my leave to

(Print name of recipient)

I am aware that I must retain a minimum balance of ten (10) days of annual vacation leave if I am donating vacation

leave or one hundred seventy six (176) hours of sick leave if I am donating sick leave in order to be eligible to

participate in the leave sharing program. I have read and understand the criteria (listed on the reverse side of this

form) which will be used in determining my eligibility to participate and how it may affect my annual vacation and/or

sick leave balances.

__________________________________________________

________________________

(Employee Signature)

(Date)

__________________________________________________

________________________

(Payroll Supervisor/Designee)

(Date)

Reference RCW 28A.400.380, RCW 41.04.650-670 and Board Policy & Procedure 5406

Note: I am aware that the elimination period for long-term disability is 90 calendar days.

_____________________________________________________________________________________

PAYROLL USE ONLY

Request Denied (Notification sent to donor)

Reason for Denial

(Payroll Supervisor/Designee)

(Date)

(Administrators, Custodians, Year Round Secretaries, etc)

---

ELIGIBLITY REQUIREMENTS

The following explanations are to be used to assist you in determining if you are eligible to participate in

the leave sharing program:

1. If you accrue annual vacation leave and sick leave, you are eligible to donate annual vacation

and/or sick leave to the leave sharing program.

2. Only days in excess of ten (10) days of annual vacation leave or one hundred seventy six (176)

hours of sick leave may be used as donation to the leave sharing program. You may donate as

many days/hours as you wish, as long as the leave balance does not drop below ten (10) days for

annual vacation leave or one hundred seventy six (176) hours for sick leave.

3. A ‘day’ of annual vacation leave is determined by the length of the donating employee’s regularly

scheduled work hours per day.

4. The donated sick leave is on an hourly basis. Each hour shall consist of the donating emp loyee’s

regularly scheduled work day at the time of conversion.

5. The donated annual vacation leave conversion shall be calculated on an hourly basis. Each day

shall consist of the donating employee’s regularly scheduled work day at the time of conversion.

6. Your annual vacation leave balance will be reduced by the number of days, converted to hours,

donated to the leave sharing program.

7. All donated annual vacation leave and/or sick leave must be given voluntarily. No employee shall

be coerced, threatened, intimidated, or financially induced into donating vacation leave and/or sick

leave.

8. Annual vacation leave and sick leave donations will be withdrawn from the donor’s leave

balance(s) only as needed and used by the designated recipient and/or the shared leave pool. Only

those employee’s represented by the EEA Collective Bargaining Agreement may donate sick leave

to the shared leave pool. All employees may donate leave to a designated recipient.

9. Donations shall be withdrawn in the order received.

10. You will be notified if any or all of your donated leave is not needed by the designated leave

recipient, and such excess donations will not be charged against your leave balance.

11. Payroll does not disclose the name of a donating employee to the recipient. All leave donations

are kept confidential.

12. Certificated staff may donate sick leave to classified staff and classified staff may donate sick

leave and/or vacation to certificated staff.

13. Donation of leave is limited to employees within the same school district.

Any additional questions concerning the donation of leave should be direct to the Payroll Office at (425)

385-4160.