Donor Request Form

1
Any employee who is eligible to accrue sick leave is eligible to participate either as a donor or as a recipient of the Donated Leave Program and must satisfy each of the following requirements:

Leave Accrual Requirements
A leave donor shall have at least 160 hours of accrued sick leave and at least 96 hours of accrued annual leave remaining after the leave donation.

Minimum Donation
Time must be donated in hour increments only.

Continued Service Requirements
A leave donor must be an active employee at the time the donated leave hours are utilized by the leave recipient. Leave donations made by separated, retiring (within the next 480 hours) and retired employees are prohibited.

Return of Unused Leave
Leave donations are utilized in the following order:

1. Sick Leave only donations first, largest to smallest, then alphabetical.

2. Annual Leave donations last, largest to smallest, then alphabetical.

Unused leave donations will not be deducted from the donor's leave bank. Unused leave donations will expire 12 months from their donation. A donor's leave donation may be deducted at any time within that 12 month period.
2
Please provide the Donor's (person donating sick or annual leave) Name.* This field is required.
First Name
Last Name
3
Please provide the Donor's (person donating sick or annual leave) Primary Phone number* This field is required.
Area Code
Phone Number
4
Please provide the Donor's (person donating sick or annual leave) email address.* This field is required.A copy of this request will be sent to your email for your records. Your donor will need a copy of this request to submit with their Donated Leave Application.
example@example.com
5
Please select the Donor's (person donating sick or annual leave) Department/Agency:* This field is required.
Agriculture
Education (Department of)
Board of Education
Career and Technical Education Board
Casino Control Commission
Collective Bargaining
Corrections Bureau
Economic Development Authority
Economic Research
Election System
Energy Office
Finance
Fire Service
Government Employees' Retirement System
Governor's Office
Health
Housing Authority
Housing Finance Authority
Human Services
Information Technology
Inspector General - V.I.
Internal Revenue
Juan Luis Hospital
Judicial Branch
Justice
Labor
Law Enforcement Planning Commission
Legislature
Licensing and Consumer Affairs
Lieutenant Governor's Office
Lottery
Magens Bay Authority
Management and Budget
Motor Vehicles
National Guard
Nurse Licensure
Personnel
Planning and Natural Resources
Police Department
Port Authority
Property and Procurement
Public Broadcasting System
Public Defender - Territorial
Public Employees Relations Board
Public Finance Authority
Public Services Commission
Public Works
Schneider Regional Medical Center
School Construction and Maintenance
Sports, Parks & Recreation
Taxicab Commission
Tourism
University of the Virgin Islands
Veterans Affairs
viNGN
VITEMA
Waste Management Authority
Water and Power Authority
West Indian Company
Test
6
Please provide the Donor's (person donating sick or annual leave) Employee Number.* This field is required.
7
Please provide your Donated Leave Recipient's (person receiving sick or annual leave) Name.* This field is required.
First Name
Middle Initial
Last Name
Suffix
8
Please provide the email address of your Donated Leave Recipient's (person receiving sick or annual leave).* This field is required.Your leave recipient needs a copy of this request to attach to their donated leave request.
9
Please provide your Donated Leave Recipient's (person receiving sick or annual leave) Employee Number:* This field is required.
10
Please provide your Leave Recipient's (person receiving sick or annual leave) Department:* This field is required.
Agriculture
Education (Department of)
Board of Education
Career and Technical Education Board
Casino Control Commission
Collective Bargaining
Corrections Bureau
Economic Development Authority
Economic Research
Election System
Energy Office
Finance
Fire Service
Government Employees' Retirement System
Governor's Office
Health
Housing Authority
Housing Finance Authority
Human Services
Information Technology
Inspector General - V.I.
Internal Revenue
Juan Luis Hospital
Judicial Branch
Justice
Labor
Law Enforcement Planning Commission
Legislature
Licensing and Consumer Affairs
Lieutenant Governor's Office
Lottery
Magens Bay Authority
Management and Budget
Motor Vehicles
National Guard
Nurse Licensure
Personnel
Planning and Natural Resources
Police Department
Port Authority
Property and Procurement
Public Broadcasting System
Public Defender - Territorial
Public Employees Relations Board
Public Finance Authority
Public Services Commission
Public Works
Schneider Regional Medical Center
School Construction and Maintenance
Sports, Parks & Recreation
Taxicab Commission
Tourism
University of the Virgin Islands
Veterans Affairs
viNGN
VITEMA
Waste Management Authority
Water and Power Authority
West Indian Company
Test
11
Please indicate the leaves you would like to donate.* This field is required.
Sick Only
Annual Only
Sick & Annual
12
Annual Leave Balance* This field is required.Please provide the number of annual leave hours you have accrued as of your last paycheck.
13
Sick Leave Balance* This field is required.Please provide the number of sick leave hours you have accrued as of your last paycheck.
14
Annual Leave Donation* This field is required.Please indicate the number of hours you would like to donate. These hours can be transferred anytime within the next 12 months.
15
Sick Leave Donation* This field is required.Please indicate the number of hours you would like to donate. These hours can be transferred anytime within the next 12 months.
16
Please provide the number of leave hours to be donated.
Annual Leave
Sick Leave
17
Hourly Rate of Pay* This field is required.
18
Active Status Requirement* This field is required.Are you retiring or resigning within the next 3 months?
YESNO
19
Signature* This field is required.
20
Get Page URL
21
Request Status
Request Received
Request Received
Pending- Donated Leave Application not received.
Denied-Donor Form incorrectly filled out and cannot be used.
Denied-The donor withdrew their donor submission.
Denied- Employee does not have enough remaining annual leave hours.
Denied- Employee does not have enough remaining sick leave hours.
Denied- Employee has separated from government.
Denied-Sick leave is not transferable between central government and semi-autonomous agencies or between semi-autonomous agencies.
Pending Evaluation
Denied- Donation not required at this time.
Closed- Donation will not be utilized.
Closed- Remaining leave balance hours will not be utilized.
Accepted in part- Part of the donation will be utilized.
Approved- Submitted to Finance for leave transfer.
22
Number of HoursThese hours have been or will be deducted from your leave balance within the next 90 days.
Sick (you must have at least 160 hours remaining after donating)
Annual (you must have at least 96 hours remaining after donating)
23
Reply to Email* This field is required.
example@example.com
Should be Empty: