Adoption Date: 06/22/2021

History: 02/22/22 (reviewed), 12/13/22 (reviewed), 12/12/23 (reviewed)

I hereby request to retire voluntarily from service in the Iowa City Community School District (“District”), effective June 30 (year). I qualify for the Early Retirement Benefit according to District criteria:

• Accumulated the required number of years of employment with the District by June 30 (year)
• Employed and worked for the entire contract year in which the early retirement benefits request is made.
• Eligible for receipt of IPERS retirement benefits or allowance pursuant to Chapter 97B of the Iowa Code
•  Am (or will be) at least 55 years of age as of June 30 (year)
• Employed in good standing and deemed eligible for the benefit by the District’s Board of Directors.

The (current school year) offered benefit (please check appropriate choice):

___  I am electing to retire June 30 (year). Stipend for employees that have been in the district for more than 15 years will be (insert)% of base salary**

___  I am electing to retire June 30 (year). Stipend for employees that have been in the district for 7-15 years will be (insert) % of the base salary**

**Base salary is the employee's (current school year) contract salary but excludes TSS (teachers), any stipends, overtime, extended days, summer school wages, etc.

GENERAL GUIDELINES

The district shall make an employer contribution to its Special Pay Deferral Plan (SPDP) in an amount computed above for the respective employee. The contribution will be made in October (year) following retirement and subject to Internal Revenue Service annual contribution limits. To receive the enhancement, a hard copy of the application must be received, and date-stamped, in HR by 4:00 p.m. on (date). The Stipend for qualifying employees who submit after (date), will be 50% of the base salary. The last date to qualify for the 50% is (date).

I have read the above and am applying to receive the District's early retirement benefit. I understand that by taking the early retirement benefit, I am no longer eligible to work in the Iowa City Community School District in the same employment capacity / employment group (ie. If I am a teacher, I understand I cannot return to the district in a teacher role or other certified staff position). This agreement does not prohibit me from serving in a substitute employee capacity. In addition, this letter constitutes my written letter of intent to retire.

______________________________________     _______________________
Employee Signature                                                 Date
______________________________________    _______________________
Employee Name                                                      School/Department  

*This form is an example. The official form is published annually by Human Resources.