California State University, San Marcos
Human Resources Management


Donation of Leave Credit for
Catastrophic Illness
(Limited to 32 hours per fiscal year)
Name:                                                      Social Security #                                                    

I,                                                                                          authorize Human Resources Management / Payroll Services to transfer:

                 

hours of my accumulated sick leave and/or

                 

hours of my accumulated vacation leave to:
(Recipient Name)                                                                                             

                                                                 

                                  

Donor Signature

Date

Complete Top Portion Only
Please Return Entire Form to Payroll Services

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CATASTROPHIC LEAVE DEDUCTION
(To Be Completed by Payroll Services)
DATE:
TO:
FROM:

Thank you for your Catastrophic Leave donation. We have received and deducted your contribution of ___________ hours from your accumulated sick/vacation leave.

These hours have been credited to                                                                                    .

Please confirm this transaction with your department attendance clerk.