I, the undersigned employee of the Harrison County Board of Education, have received, read and understand the information in the Personal Leave Donation Program.
I wish to make a contribution from my personal leave of Number of Days* days (no more than 5 days per year may be donated to a recipient employee who is not a spouse to):
A letter from a physician licensed to practice in the state of West Virginia must accompany this request (or already be on file in the Personnel Department The letter must provide sufficient information to make a determination as to whether an employee is incapacitated with the meaning of "catastrophic medical emergency" (medical condition that incapacitates an employee or a member of the employee's immediate family for whom the employee will provide care, which medical condition is likely to require the prolonged absence of the employee from duty