Leave of Absence

Report your arrangement for a leave of absence in Part 3.

Employer or Party


Status and Terms


East State University

Fresno, CA

I will take an unpaid, two-year leave of absence from my faculty position. 


East State University

Fresno, CA

I will continue to participate in the East State 403(b) plan.  The university will not make contributions during my leave.


For You

Part 3

Report an arrangement that you have for a leave of absence.  In addition, if you are an Annual or Termination filer, report any arrangement for a leave of absence that you had at any point during the reporting period.

Employer or Party:  Provide the name of the employer.

City/State:  Provide the city and state in which the employer is located.

Status and Terms:  Briefly describe the type of arrangement and its terms.  In particular, indicate whether the leave is paid or unpaid and specify the duration of the leave.  Also, indicate whether your employer will continue to make contributions to any retirement or benefit plans.

Date:  Provide the month and year in which the leave of absence began.  If the leave has not yet begun, you may enter the current month and year.

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