CHECK-OUT LIST
FACULTY AND ACADEMIC STAFF
NAME (please print):_____________________________________________________________________________
DEPARTMENT/SCHOOL/UNIT:_____________________________________________________________________
Upon completing your current employment at the University of Wisconsin-Stevens Point, please clear the
following items:
CLEARANCE ITEM
TO BE CLEARED BY:
SIGNATURE
1.
Grade Reports
1.
Registrar
1.
__________________________
2.
Department/Division/School
Functions (KEYS--faculty office,
laboratory, studio, office, building,
desk and file; COMPUTER
EQUIPMENT--home and office)
2.
Chair or Associate Dean or
Administrative Head
2.
__________________________
3.
Library Books, Periodicals, etc.
3.
Exec. Director, Academic Success
3.
__________________________
4.
Travel Advances, VISA Corporate
Travel Card
4.
Travel Coordinator
4.
__________________________
5.
Change Funds/Tax Exempt Card
(if applicable)
5.
Payment Services Manager
5.
__________________________
6.
Visa Purchasing Cards
6.
Purchasing Manager
6.
__________________________
7.
Insurance, Retirement and
Forwarding Address (Please call
the Staff Benefits Office at X-4677
to schedule an appointment.)
7.
Staff Benefits Specialist (Human
Resources Office, 133 Main
Building)
7.
__________________________
NOTE:
 You may wish to contact other offices on campus to determine whether you have indebtedness to them or have a refund
coming. Faculty and academic staff leaving the university during the year may receive a partial refund on their parking
decal. (The decal must be removed from the car and returned to Parking Services for a partial refund.)
 If you wish to have your payroll check mailed to a new address, please contact the Staff Benefits Office (X-4677).
 The Human Resources/Staff Benefits Office has available a leaflet which may be helpful in your determination as to
whether or not to leave your Wisconsin Retirement funds on deposit if you are permanently leaving the university.
FORWARDING ADDRESS:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
____________________________________________________
SIGNATURE
DATE
PLEASE LEAVE THIS FORM WITH THE STAFF BENEFITS SPECIALIST IN THE HUMAN RESOURCES/STAFF
BENEFITS OFFICE, ROOM 133 MAIN BUILDING.
Academic Affairs/Rev. 6-05-15