WTU Leave Banks Opt Out Form for the Sick and the Parental Leave Banks

Important Notice: Leave Bank Opt-Out Form

This form is intended solely for members who wish to opt out of the WTU Sick Leave Bank and/or Parental Leave Bank. Please note that opting out will remove you from participation for the entire following school year.

If you choose to re-enroll at a later date, the mandatory 90-day waiting period will reset and begin from the date of your re-enrollment.

For questions regarding the Sick Leave or Parental Leave Banks, please contact the WTU Membership and Benefits Team at leavebanks@wtulocal6.net.

Please note: This form is only for opting out of the Sick Leave and Parental Leave Banks. It does not apply to Dental or Vision benefits. If multiple opt-out forms are submitted, only the most recently dated submission will be honored.

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Email *
DCPS Employee ID *
Last Name *
First Name *
Date of Birth *
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DD
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YYYY
Gender *
Country *
Street Address 1 *
Street Address 2
City *
State *
Zip Code / Postal Code *
Home Phone *
Cell Phone *
Job Title *
Required
Location / School *
 Please confirm which action you are completing. *
Bank *
Date of hire *
MM
/
DD
/
YYYY
 Date of Enrollment (Complete if new enrollment only)
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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