Sick Leave Donation

"*" indicates required fields

Complete the Fields below:

Name*

First Last

URI Title*

Department*

Phone Number (###)###-####*

URI Email*

Enter Email Confirm Email

(Choose one) I work*

Full Time

Part Time

Standard Work Week*

35 hrs.

40 hrs.

Do you have maximum sick time accrual (875/1000 hrs)?

Yes

Authorization and Consent

I authorize the Office of Human Resources at the University of Rhode Island to transfer one sick day from my accrued sick leave to the PTAA Sick Leave Pool.

Date of Submission*

Phone

This field is for validation purposes and should be left unchanged.