Leave Donation Program Enrollment
Enroll to donate your accrued leave to colleagues in need. Complete all required sections to participate in the program.
Full Name
*
First Name
Last Name
Employee ID
*
Department
*
Work Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Employment Status
*
Full-Time
Part-Time
Contractor
Type of Leave to Donate
*
Please Select
Vacation Leave
Sick Leave
Personal Leave
Other
Amount of Leave to Donate (in hours)
*
Current Leave Balance (in hours)
*
Are you donating to a specific recipient?
*
Yes
No (donate to general pool)
If yes, enter the recipient's full name
Reason for Donation or Comments (optional)
Signature (Please sign to authorize your leave donation)
*
Submit Enrollment
Submit Enrollment
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