Untitled Document

	Spousal Sick Leave Donation Form

Donor Information:
Name of Donor:	EKU ID:
Phone Number:	Hire Date:
Department:
Days to be credited to Recipient: (Employee must have 10 days remaining after donation. Minimum amount employee may donate is five days.)

Recipient Information:
Name of Recipient:	EKU ID:
Phone Number:	Hire Date:
Department:


Signature of Donor	Date
This is to certify that the employee named above has a sufficient sick leave balance to donate the hours indicated leaving a minimum balance of 10 days.

Human Resources Authorization	Date