Voluntary Faculty Phased Retirement Program Request Form

I formally submit my application for phased retirement in accordance with the University's Voluntary Faculty Phased Retirement Program and confirm that I meet the eligibility requirements. I understand that the Voluntary Faculty Phased Retirement Program extends for two years with retirement occurring at year three.

Faculty Details
Name Name First Last
Employee Number:
Department:
Position:
Faculty Status

Faculty Status Tenured Non-Tenured
Faculty Email
Dean

Dean Shaily Menon - College of Arts & Sciences Brian Kench - Pompea College of Business David Schroeder - Henry C. Lee College of Criminal Justice and Forensic Sciences Ron Harichandran - Tagliatela College of Engineering Betsy Francis-Connolly - School of Health Sciences
Phased retirement plan dates (must be the beginning of academic year):
Year one: Sept. 1, 2025
Year two: Sept. 1, 2026
Retirement Date: Sept. 1, 2027

Year one: Sept. 1, 2025
Year two: Sept. 1, 2026
Retirement Date: Sept. 1, 2027 I acknowledge the dates listed above.
Number of Credit Hours in Year One
Number of Credit Hours in Year Two
I hereby certify that I have read, understand, and agree to the terms and conditions associated with the Voluntary Faculty Phased Retirement Program. I understand that participating in this program is voluntary and that the decision to participate may not be revoked once executed. I also understand the applicable University representatives will review my application for this program and determine the feasibility and approval of my subsequent participation.

The University reserves the right to approve or reject my application based on the potential implications on University operations to deliver specific services to students, which may impede on its ability to deliver on the University's mission.

I understand that the Voluntary Faculty Phased Retirement Program does not affect my employment relationship with the University and that entering into this voluntary agreement does not restrict the University's ability to terminate my employment for cause, subject to the terms and conditions of the faculty handbook, and that performance expectations must be met. I continue to recognize that I must follow the rules, regulations, and policies of the University as they presently exist or are subsequently modified.

If my application is approved and I participate in the Voluntary Faculty Phased Retirement Program, I remain eligible to participate in the employee group health insurance program. This participation will end upon my termination of employment unless I elect to continue the coverage through COBRA. I also understand that during the course of this phased period my participation and contribution toward the cost of medical benefits will be based on the stipulations and rates applicable to part-time faculty or staff.*

Lastly, I understand that this program is being offered without setting precedent for future similar matters and that the University may cancel or amend this program at its sole discretion. I understand that at the conclusion of my successful participation in this program, and based on the terms and conditions set forth, I will receive a lump sum payment of $5,000 which will be less customary and mandatory deductions. This payment is ineligible for 403b contributions.

*Faculty are eligible for full University benefits while maintaining a minimum of 24 credit hours. Costs are adjusted to reflect a part-time contribution rate if teaching credit hours fall between 12 and 23 in year two. Faculty carrying less than 12 credit hours are not considered benefit eligible.
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Date Date / MM / DD YYYY

Voluntary Faculty Phased Retirement Program Request Form

Voluntary Faculty Phased Retirement Program Request Form

Faculty Details

Phased retirement plan dates (must be the beginning of academic year):