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Please sign and return Donation form to Deborah J. Sobczak PSA SLB Committee Chair MS 608 if you wish to be a member of the Sick Leave Bank. Donation forms must be received by March 31 2013. Signature Date For Office Use Only Date Processed Initials Sick Leave Bank Open Enrollment Employees who have not already enrolled in the PSA Sick Leave Bank have the opportunity to do so from March 1 through March 31 2013. Can I cancel my membership in the SLB Yes. Contact the Chair of the SLB committee. How do I apply to use hours The Application Form is available online at the HR Web site. Questions Please visit our PSA Web site www. utoledo. edu/org/psa/ for entire policy guidelines or contact the Sick Leave Bank Chair Deborah J. Sobczak at 419-530-2010. What is the Sick Leave Bank The Sick Leave Bank is excess sick time hours contributed by PSA members to be used by PSA members who have had a personal catastrophic illness or injury and have exhausted their own vacation and sick time. Who is eligible to join the SLB Any PSA or classified-exempt employee on any UT campus who has a minimum of 48 hours of personal sick time. How do I join Complete and return the SLB Donation form to Deborah J. Sobczak MS 608 no later than 3/31/2013. The University of Toledo Professional Staff Association PSA Sick Leave Donation Form Please Print Name of Donor Employee Last First Middle Rocket Number Title of Donor Employee Department / Location / Mail Stop Office Telephone Amount to donate please check one Part Time Employee donate 8 hours 1 day one-time donation to sick leave bank to become a member Full Time Employee donate 16 hours 2 days I hereby authorize the Payroll/Human Resources Department to deduct from my sick leave balance the number of hours indicated above to be used as sick leave by the Professional Staff Association Sick Leave Bank. What is the Sick Leave Bank The Sick Leave Bank is excess sick time hours contributed by PSA members to be used by PSA members who have had a personal catastrophic illness or injury and have exhausted their own vacation and sick time. Who is eligible to join the SLB Any PSA or classified-exempt employee on any UT campus who has a minimum of 48 hours of personal sick time. How do I join Complete and return the SLB Donation form to Deborah J* Sobczak MS 608 no later than 3/31/2013. Do I have to join No it is completely voluntary. Do I need to Re-Enroll Each Year No your one-time contribution makes you a member as long as you are employed at UT. Can I cancel my membership in the SLB Yes. Contact the Chair of the SLB committee. How do I apply to use hours The Application Form is available online at the HR Web site. Questions Please visit our PSA Web site www. utoledo. edu/org/psa/ for entire policy guidelines or contact the Sick Leave Bank Chair Deborah J* Sobczak at 419-530-2010. What is the Sick Leave Bank The Sick Leave Bank is excess sick time hours contributed by PSA members to be used by PSA members who have had a personal catastrophic illness or injury and have exhausted their own vacation and sick time. Who is eligible to join the SLB Any PSA or classified-exempt employee on any UT campus who has a minimum of 48 hours of personal sick time.

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