Kansas State University
Voluntary Phased Retirement Program
Unclassified Faculty/Staff
Transmittal Form
Attached is a proposal for
(faculty/unclassified professional)
for the Phased Retirement Program effective
at
tenths time for a
year period with the proposed ending
date of
[Dean's Office: Please fill out the bottom box before submitting the
transmittal form to the Office of the Provost and Senior Vice
President. The proposal must include a detailed description of the
anticipated responsibilities for the reduced appointment.]
The undersigned have reviewd and recommend approval of this proposal.
_________________________
Department Head or Director
____________________
Date
_________________________
Dean or Vice President
____________________
Date
_________________________
____________________
Provost and Senior Vice President Date
To be completed by the Dean's Office prior to submission:
Current title of faculty/unclasified professional member:______________
Appointment: 9-month_____ 12-month____ Current salary:__________
Current FTE:_________
Date of Birth:_____________
Home address_______________________________________________
Street
City
State
Zip