Free 24315.pdf - Indiana

LEAVE OF ABSENCE VERIFICATION
State Form 24315 (R7 / 6-08)

INDIANA STATE TEACHERS' RETIREMENT FUND 150 West Market St., Suite 300 Indianapolis, IN 46204-2809 Telephone: (317) 232-3860 / (888) 286-3544 Fax: (317) 232-3882 Home page: http://www.in.gov/trf PRIVACY NOTICE Your TRF number is required on this form. Without it our agency cannot process your request. To obtain your number, feel free to call our office at (317) 2323860 or toll-free at (888) 286-3544.

Approved by State Board of Accounts, 2008

Employer: Please attach a copy of the Leave of Absence agreement or a copy of the board minutes. Please read the additional instructions on the 2nd page of this form.

MEMBER DATA
Name of member Date (month, day, year)

Address (number and street) New address

TRF number (required)

City

State

ZIP code

Telephone number

LEAVE OF ABSENCE DATA Subject to one-seventh (1/7 ) Rule. Please check the type of leave below:
Sabbatical / Professional Improvement (Requires return to Indiana teaching for equal time) Sick leave Advanced study Work experience Teacher exchange program Disability Approved educational travel Military Service Military service leave Date beginning (month, day, year) Family and Medical Leave Act (FMLA) (for vesting purposes only) Date ending (month, day, year) Pregnancy leave Compensation, including any sick leave Other Adoption leave Amount of TRF contribution, if any Sickness or Disability Other school board approved leave (not eligible for service credit) th

EMPLOYING OFFICIAL'S STATEMENT
I attest that the above described leave of absence was approved by the Board of Trustees. I further attest that the terms of the leave of absence agreement were satisfactorily met by the teacher.
Are the employee's 3% contributions picked up by the employer? (circle one)
School unit Date signed (month, day, year)

Yes

No

Employing official signature

Name of school

Employing official printed name

Address (number and street)

Employing official title

City

State

ZIP code

Employing official telephone number Employing official fax number

CONTINUED ON 2ND PAGE

ADDITIONAL INSTRUCTIONS
To receive a leave of absence eligible for TRF service credit, the leave must be for one of the following reasons: · Advanced study · Disability · Work experience · Teacher exchange program · Approved educational travel · Pregnancy leave · Sick leave

· Military service leave

· Family and Medical Leave Act (FMLA)

· Adoption leave

The Indiana State Teachers' Retirement Fund (TRF) will only recognize the above-listed leaves for service credit. All other leaves, including personal leaves, are not recognized for service credit. If the leave is for advanced study, work experience, a teacher exchange program, or approved educational travel, the teacher must return to a position covered by TRF for the same amount of time that was granted for the leave. For example, if a member was granted a one year leave of absence, that member would then need to return to teaching for one year before service credit would be added to the member's record. All leaves are subject to the one/seventh (1/7 ) rule. This rule states that leave credit is limited to one-seventh of the total years of service claimed by a member for retirement purposes. A leave of absence cannot be granted until the fiscal year (July 1 through June 30) in which the leave occurred is completed and all requirements have been satisfied. The leave must be officially approved and verified by the school corporation. A leave of absence must be verified on this form. A copy of the board minutes or leave of absence agreement approving the leave of absence must be submitted with this form.
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OTHER SCHOOL BOARD APPROVAL LEAVES (NOT ELIGIBLE FOR SERVICE CREDIT)
A leave of absence may be granted for which the member does not receive retirement service credit from TRF. Teachers who return from such leaves return to the particular fund (Pre-`96 or `96 Fund) to which they belonged prior to the leave of absence. Mark the "Other School Board Approved Leave" box on this form; return with copies of the board minutes referring to the leave of absence.

MILITARY SERVICE LEAVE
Leaves of absence that qualify for military service credit originate from two sources. Some varieties of military service credit for leave are authorized by federal legislation. These types of creditable leaves apply when a member leaves a teaching position, serves on active duty in the military, and returns to the position they left to enter the military. A member is entitled to military service credit in the amount required by the Veterans Reemployment Rights Act (38 USC 4301 et seq.), as recently amended by the Uniformed Services Employment and Reemployment Rights Act of 1994. The second type of credit is authorized by Indiana law (IC 5-10.4-4-8). Please note that military service rendered years ago must still be verified by TRF for the teacher. Copies of college transcripts, military form DD214, and other relevant documents may be required.

FAMILY AND MEDICAL LEAVE ACT (FMLA)
FMLA is covered by special Federal law that includes service credit only if needed for vesting. TRF will evaluate each application separately.

EDUCATION OR SICK LEAVES TAKEN PRIOR TO JUNE 1974 REQUIRE DIFFERENT VERIFICATION
Specifics will be provided as requested.

PRE-96 FUND OR 96 FUND MEMBERSHIP
Teachers returning from a leave of absence under TRF laws retain membership in the particular Fund (Pre-96 Fund or 96 Fund) to which they belonged prior to the leave of absence.