The University of North Carolina at Wilmington

TENURED FACULTY VOLUNTARY SEPARATION INCENTIVE PROGRAM APPLICATION

NAME: ______EID: ______TITLE: ______SUPERVISOR: ______DEPT: ______DIVISION/COLLEGE: ______The employee and the supervisor must initial each appropriate bullet to certify that the employee meets the criteria listed below: EMP SUPV ______Employee is currently tenured. ______Employee is currently in academic role and does not have administrative responsibilities at the Vice President, Associate Vice President, Vice Provost or Dean level. ______Employee is not tenured librarian ______Employee does not have a specific separation date already agreed to in writing prior to the opening of the TFVSIP program or has not accepted other employment in a tenured or tenure- track position at another institution of higher education. ______Employee is not currently in a Phase In Retirement Program

Lump sum payment amount: $ ______FY15 “B” Base Budgeted Salary: $ ______Separation date: June 30, 2015 Employee acknowledges that UNLV’s Tenured Faculty Separation Incentive Program is voluntary. Completion of this application is in no way binding upon the employee or the University. The University reserves the right to accept or deny requests at its discretion. If the employee and the University mutually agree upon the employee’s participation in this program, additional documents will be signed. If the employee decides he/she is no longer interested in the Program after submitting this request, the employee must immediately notify the Executive Vice President & Provost in writing. Employee Signature: ______Date: ______The following signatures indicate endorsement of the application, but do not constitute a contract.

______Supervisor Date Dean Date

______Chairperson/Dept. Head Date Executive Vice President Date & Provost

VSIP Application Page 1 of 2 FOR SUPERVISORS:

___ Application received from employee by 03/02/2015.

___ Lump sum amount: ______(amount is the lesser of 100% of FY15 “B” base)

___ Once Employee and Supervisor signs the application, fax copy to HR at 5-1545 (Attn: Lily Magana)

VSIP Application Page 2 of 2