KANSAS STATE UNIVERSITY
VOLUNTARY PHASED RETIREMENT PROGRAM
UNCLASSIFIED FACULTY/STAFF TRANSMITTAL FORM


TO:    Provost and Senior Vice President Nellis/Vice President Krause/Vice President Rawson

RE:    Phased Retirement Proposal

Attached is a proposal for (faculty/staff member) for

the Phased Retirement Program effective

at tenths time for a year period with

a proposed ending date of .

The undersigned have reviewed and recommend approval of this proposal.

____________________________
Department Head/Director
____________________________
Date
  
____________________________
Dean
____________________________
Date
  
____________________________
Provost
____________________________
Date

Please forward to the Office of Academic Personnel, 204 Anderson Hall.

Proposal must include a description of the responsibilities for the reduced appointment.

For Dean's Office Use Only:

Current title of faculty/unclassified professional member: ________

__________________________ 9/12 Appt. 9___ 12________

Current salary: _____________ Date of Birth: ______________

Home address:_________________________________________
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