TENURED FACULTY VOLUNTARY SEPARATION
INCENTIVE PROGRAM APPLICATION
NAME: ________________________________________
EID: _____________________________
TITLE: ________________________________
SUPERVISOR: ________________________________
DEPT: _________________________________
DIVISION/COLLEGE: _________________________
The employee and the supervisor must initial each appropriate bullet to certify that the employee meets the
criteria listed below:
EMP SUPV
____
____ Employee is currently tenured.
____
____ Employee is currently in academic role and does not have administrative responsibilities at the
Vice President, Associate Vice President, Vice Provost or Dean level.
____
____ Employee is not tenured librarian
____
____ Employee does not have a specific separation date already agreed to in writing prior to the
opening of the TFVSIP program or has not accepted other employment in a tenured or tenuretrack position at another institution of higher education.
____
____
Employee is not currently in a Phase In Retirement Program
Lump sum payment amount:
$ _________________________
FY15 “B” Base Budgeted Salary:
$ _________________________
Separation date: June 30, 2015
Employee acknowledges that UNLV’s Tenured Faculty Separation Incentive Program is voluntary.
Completion of this application is in no way binding upon the employee or the University. The University
reserves the right to accept or deny requests at its discretion.
If the employee and the University mutually agree upon the employee’s participation in this program,
additional documents will be signed. If the employee decides he/she is no longer interested in the Program
after submitting this request, the employee must immediately notify the Executive Vice President & Provost
in writing.
Employee Signature: _______________________________
Date: __________________________
The following signatures indicate endorsement of the application, but do not constitute a contract.
______________________
Supervisor
________________
Date
______________________
Dean
_________________
Date
______________________ _________________
Chairperson/Dept. Head
Date
______________________
Executive Vice President
& Provost
________________
Date
VSIP Application Page 1 of 2
FOR SUPERVISORS:
___ Application received from employee by 03/02/2015.
___ Lump sum amount: ___________________ (amount is the lesser of 100% of FY15 “B” base)
___ Once Employee and Supervisor signs the application, fax copy to HR at 5-1545 (Attn: Lily Magana)
VSIP Application Page 2 of 2