The Retirement, Faculty / Academic Staff form is initiated by the faculty/academic staff member who gives notice that they wish to retire. The department should fill in the form.
(Current form = RETR0105, White)
Name: As recorded on the Social Security card (last name, first middle; 30 space limit).
Social Security #: Check for accuracy.
Date of Birth: MM/DD/YYYY format.
Position #: Provide the full position # (letters which designate the college/MAU plus the number).
Spouse/Partner Name: Name of spouse or partner. If there is a spouse/partner, provide their social security number and date of birth.
Home Address: Include a complete mailing address.
Home Phone: Provide area code and home telephone number.
Position/Rank 1, Position/Rank 2, and Position/Rank3: List the position/rank(s) that are held at the time of retirement. Non-current position/ranks may be listed if they were held for a substantial period of time and can be held in conjunction with the other position/ranks listed (for example, Consultant, Coordinator, Editor, etc. could be listed in addition to Professor). If no position/rank is applicable leave blank. See University Approved Position/Ranks; also Faculty Handbook “Emeritus” .
Title 1 and Title 2: Leave blank if there is no title to be recommended for emeritus status. See University Approved Academic Titles; also Faculty Handbook “Emeritus”. The emeritus designation is not normally awarded to titles held on an acting basis.
For individuals whose administrative appointment requires approval by the Board of Trustees and for all executive managers, list the most senior administrative title held at or prior to retirement. The emeritus designation for this title is subject to approval by the Provost and the President. One additional title (neither executive management nor Board-approved) may be listed, if desired, in addition to the executive management or Board-approved title.
In the absence of an executive management or Board-approved title, up to two titles (neither executive management nor Board-approved) may be listed. The title(s) may be held at or prior to retirement.
Executive management titles are identified by a number one (1) on the University Approved Academic Titles list. Board-approved titles that are not executive management are Dean, Director of Libraries, Director of Honors College, Director of National Superconducting Cyclotron Laboratory, Head Basketball Coach, Head Football Coach, Head Hockey Coach, Faculty Grievance Official, Ombudsman, and Secretary for Academic Governance.
Pos/Rank/Title (freeform, optional): Use this line, if desired, to further specify a position/rank and/or title. (For example, the position/rank of “Coach” can be specified as “Women’s Volleyball Coach”; a title of “Director” can be further specified as “Director of Graduate Studies”. The space is limited to 30 characters.)
Department/College: The primary department/college has administrative responsibility for the employee. If there is more than one department, list each department/college with the primary unit first. Provide the full department name or the 18 character common unit code abbreviation. For the department code, use the three-digit department common unit code; for the college code, use the two-digit college common unit code.
I request retirement effective on the first day of: Provide the month and year (YYYY) of retirement.
For academic year (AY) faculty/academic staff the effective day of retirement is January 1, February 15, July 1or August 16. (For those retiring January 1, the December pay check will include payment for the period December 1 through February 15. For those retiring July 1, the May paycheck will include payment for the period May 1 through August 15.)
For annual year (AN) faculty/academic staff, the usual day of retirement is July 1, although a different month may be chosen.
I was appointed prior to January 1, 1992. I request:
Complete this section for tenure system faculty recommended for a consultantship. Tenure system faculty are eligible for a consultantship if they were appointed prior to January 1, 1992 and have not had a compensated leave (excluding short-term disability leave) within five years of their retirement date. See Faculty Handbook “Retirement”.
Dates of last paid leave: If requesting a consultantship, provide the begin and end date of the last paid leave (excluding short-term disability leave). If there have been no paid leaves, type “none” on the beginning date line.
I understand that I may revoke this application only if I do so within 7 days after signing it.
Faculty/Academic Staff Signature: The faculty/academic staff member must sign and date the form. The application for retirement may be revoked by the faculty/academic staff member only within 7 days of signing the form.
Recommended by: Signatures must be the chairperson/director's and dean/MAU administrator's name with any other initials below. In the case of a multiple appointment the signatures for each unit involved are required. Each signer must date her/his signature.
Routing: Faculty/academic staff member; all departments and colleges shown on the form; Academic Human Resources; Provost; Academic Human Resources. Distribution of copies of approved action: Academic Human Resources; Benefits Office; Payroll Office; all colleges involved; all departments involved; faculty/academic staff member.