I wish to donate the number of hours of annual leave indicated below. Donations must be made in 8-hour increments. I understand that I cannot reclaim my donated leave unless my leave donation has not yet been processed.
Date _____________________ Annual Leave Hours Donated _______________
Donor Name ___________________________________________________________
Donor SSN ____________________________________________________________
Division _______________________________________________________________
Recipient’s Name and Agency
______________________________________________________________________
Relationship ___________________________________________________________
(Complete only if inter-agency transfer)
______________________________________ ______________________
Donor Signature Date
______________________________________ ______________________
Leave Administrator Date Received
______________________________________ ______________________
Payroll Administrator Date Received