LOA Worksheet (Teachers) - Education Minnesota

LOA Worksheet: Teacher/Faculty

Data Submission due to a Leave of Absence

"*" indicates required fields

You have been identified as a person taking leave this school year from your local. To ensure your dues are assigned based on your paid working days per the Education Minnesota Constitution & Bylaws, Article II, Section 2(b), please provide the following information.

Local name:*

Your name:*

First Last

Your email:*

Leave start date:*

Return from leave date:*

Your contracted FTE prior to leave:

(example: 1.0, .65, .50)

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

Applied for MPL/district insurance

Approved

Denied

Pending/Unknown at this time

Were any of your leave days covered (or anticipated to be covered) by MPL/district insurance?*

(Excluding district holidays and weekends.)

Yes

Start date:*

End date:*

Number of days on MPL/District insurance*

District Paid Time Off (PTO, sick, sick banks)

Were any of your leave days district paid time off?*

(Excluding district holidays and weekends.)

Yes

Start date of PTO:*

End date of PTO:*

Number of days used on PTO sources:*

Unpaid leave (if any)

Were any of your leave days unpaid (not covered by MPL/district insurance or district PTO)?*

(Excluding district holidays and weekends.)

Yes

Start date of Unpaid leave:*

End date of Unpaid leave*

Number of days on Unpaid leave:*

Revised FTE Calculator

Total district duty days*

(State average is 182.)

(minus) number of days on unpaid leave*

(This does not include days on MPL.)

(equals) number of paid days in the year*

Number of paid days in the year*

(including days on MPL)

(divided by) total district duty days*

(times) your contracted FTE prior to leave*

(equals) Revised FTE

for STATE obligation purposes (if applicable)

Enter or attach any additional information or variables specific to the leave not already listed on this form:

For example, if any portion of your leave was not paid by MPL or by district funds.

Upload additional information here:

Max. file size: 100 MB.

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

Signature:*

Printed Name:*

Date*

Information will submitted to the Education Minnesota membership department.

Login to EdMN Member Portal

Go to MEA Online

Go to MEA Online

LOA Worksheet: Teacher/Faculty

Data Submission due to a Leave of Absence

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

District Paid Time Off (PTO, sick, sick banks)

Unpaid leave (if any)

Revised FTE Calculator

Sitemap

Headquarters

Contact

Follow Us

Legal

Login to EdMN Member Portal

Go to MEA Online