Voluntary Donation of Sick Leave
Certificated / Classified
(Circle one above)
Per Fiscal Year Maximum: Certificated 2 days / Classified 3 days
I, _______________________________, hereby agree to donate ______day(s) of accumulated Sick Leave, earned by me
(Donator’s Name)
to______________________________________________.
(Recipient’s Name)
I hereby agree that this donation is completely voluntary on my part and that I shall not hold the District responsible in
any way if the donated sick leave is used or not used by the designated employee.
I hereby agree that this donation of sick leave is unconditional and irrevocable. This donation is made pursuant to the
terms of Board Policy 4161.9.
Certificated employees may donate only to certificated employees.
Classified employees may donate only to classified employees.
________________________________________________
Donator’s Signature & Date
___________________
Employee I.D. #
_______________________________________________
Assistant Superintendent of Human Resources - Approval
___________________
Date
_________________
Donator’s Site