NOTICE: Comments shall be filed, in writing, with the Mid-Ohio Valley Technical Institute, 2134 North Pleasants Highway, St.

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1 ESTABLISHMENT 1 of 5 MOVTI/Administrative Council adheres to the policies and provisions as maintained by the Pleasants County Board of Education in regard to the Leave Donation Program Policy. The Administrative Council of the Mid-Ohio Valley Technical Institute hereby affirms that the employees of MOVTI will participate in the Leave Donation Program for professional and service personnel as established by the Pleasants County Board of Education. Leave Donation Program The leave donation program is designed to assist employees of the Mid-Ohio Valley Technical Institute who have an extended illness and have consumed all of their allotted sick leave, personal leave, and as applicable, vacation days. Under the program an employee may transfer accrued personal leave to the personal leave account of another employee who, because of a medical or physical condition that incapacitated the employee or an immediate family member for whom the employee will provide care, has exhausted and is not eligible to receive any of the above mentioned leave. This program will allow the employee to be paid his or her full salary during the time covered in receiving donated days. No membership is required, any agreement to donate days is strictly an agreement between the individual donating the days and the individual who is to receive those days. Procedure 1. The employee with the extended illness must provide information from a licensed physician and meet all of the following criteria. a. Have an extended illness that prevents him or her from working. b. Have the illness diagnosed and confirmed by the licensed physician. c. When the days are for use to care for an immediate family member, the employee to receive donated days must have documentation from a

2 licensed physician pertaining to the extent of the immediate family member s illness. 2 of 5 d. Have the number of days that the employee will be unable to work and the expected date of return specified by the doctor. 2. The donating employee will complete the sick leave donation form and have it notarized by a notary public. 3. All the completed forms will be submitted to the finance office for review. Specialized Criteria for Eligibility 1. Pleasants County Schools / Mid-Ohio Valley Technical Institute employees may not donate more than 10 days per school year to another employee who is not his or her spouse. 2. The maximum number of days that can be donated for a spouse is 15 days per request. Additional requests for donated days for a spouse can be made and will be retroactive to the day of need. 3. Donated days that exceed the number used may not be banked by the user, but will be returned to the donor. 4. All donations must be voluntary with the donor selecting the recipient. 5. If worker s compensation is received, the employee is not eligible to access the designated/donated sick leave program. 6. Request regarding a normal pregnancy will be denied.

3 3 of 5 MID-OHIO VALLEY TECHNICAL INSTITUTE APPLICATION FOR DAYS FROM THE LEAVE DONATION PROGRAM PERSONAL DATA Employee s Name Mailing Address Employment Location Telephone Number(s) /Home /Work /Cell MEDICAL DATA Type of illness _ Date patient can return to work It is my professional opinion that the above-mentioned patient has an extended illness that requires him/her to be unable to perform work duties. Licensed Physician Name (Print) Licensed Physician s Signature Date

4 COUNTY OFFICE DATA Approved: Yes No Date Finance Officer or Designee Signature 4 of 5 MID-OHIO VALLEY TECHNICAL INSTITUTE LEAVE DONATION PROGRAM An employee of Pleasants County Schools / Mid-Ohio Valley Technical Institute may donate leave days to another employee by the utilization of the following documentation instrument and presented to the Pleasants County Schools finance office. I, donate days of my unused leave to, another employee of the Pleasants County School / MOVTI System, who has exhausted all their sick leave, personal leave, and as applicable, vacation days due to an extended illness. I understand this donation is irrevocable and I also understand the following stipulations: personal illness. insurance coverage at the time of my retirement. credited service in the computation of monthly benefits at the time of my

5 retirement. differential between the donor and recipient. Dated: Signed: 5 of 5 State of, County of, to wit: I,, a notary public in and for the county and state as aforesaid do hereby certify that did sign his/her name to this request before me this the day of, 20. Notary Public My Commission Expires: Amended: December 13, 2007