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Sick Leave Donation Form

Please complete the form below. Required fields marked with an asterisk *

Policy GCCAA-1E (Also GDCA-1E)

Weston County School District #1

Sick Leave Donation Form

I am an employee of Weston County School District Number One. I have earned and accumulated one or more days of sick leave in accordance with District Policy. I want to donate one or more of my earned sick leave days to another District Employee. I understand that my donation is irrevocable and I cannot change my mind and cancel or annul my donation. I have read District Policy regarding donation of sick leave and I understand and agree with this policy.

I irrevocably donate

Please choose number of Days*

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days of my earned accumulated sick leave to

Please enter District Employee's name*

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This donation is not complete until the form is accepted and processed.

Dated:*

[Please select today's date]

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Please enter your Signature below*

[insert your Digital Signature file below]

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Choose a file or drag it here.

Print Name of Donor*

[Please enter your name]

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