INSTRUCTIONS (Please read before completing the form):

1. Employee shall notify their immediate manager of their resignation or retirement prior to or concurrent with notification to Human Resources.

2. At the completion of this form, a District Property Separation Checklist and Employee Separation Survey will be provided (if applicable).

3. Contact Benefits at hrbenefits@mtsac.edu to schedule a meeting to review your applicable health & welfare benefits.

To obtain detailed information regarding your retirement, contact the appropriate agency listed below:

a. CalPERS: http://www.calpers.ca.gov/ or call 888-225-7377

b. CalSTRS: http://www.calstrs.com/ or call 800-228-5453

c. National Benefits Services (NBS) (FICA Alternative Retirement Plan): www.nbsbenefits.com/403b or call 1-800-274-0503

In accordance with AP 7350, resignations accepted by the College President/CEO are final and may not be rescinded.

Any questions regarding this form, please contact hroperations@mtsac.edu.