LOA Worksheet: ESP

Request a Recalculation of State Dues Obligation as a result of Leave of Absence for an ESP

"*" indicates required fields

You have been identified as a person taking a leave of absence from your district and local. To ensure your dues are assigned correctly, please provide the following information.
Your name:*
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Salary calculator upon return from LOA

Projected full-year gross earnings before leave of absence. How much would you have been paid if there was no leave?
This is the total full-year district duty/contractual days. (Minnesota average is 182.)

Unpaid leave (if any)

Excludes MPL, PTO, holidays and weekends. Enter 0 if none.

Minnesota Paid Leave (MPL) or District insurance — MPL/Insurance portion

Pay lost per day during leave. Excludes MPL, PTO, holidays and weekends. Enter 0 if none.
This field is hidden when viewing the form
For example, if any portion of your leave was not paid by MPL or by district funds.
Max. file size: 100 MB.

I am requesting a dues recalculation to determine if I am eligible for a state dues reduction based on the formula in the Education Minnesota Constitution and Bylaws, Article II, Section 2(c).

By signing below, I affirm that my answers above are correct and accurate to the best of my knowledge, and that I will contact membership@edmn.org if any of the information I have provided here changes.

MM slash DD slash YYYY
Information will submitted to the Education Minnesota membership department.