Faculty Notification of Intent to Separate

This form should be completed by the office of the department chair or school dean at the time of notification.

By submitting this form, a copy will be automatically emailed to the following administrative units for the purpose of ensuring all issues regarding separation are resolved prior to departure:

Academic Human Resources
Center for Teaching and Learning
Human Resources - Benefits
Human Resources - Immigration Services
Equal Opportunity Compliance and Title IX
Michigan Tech Research Institute (MTRI)
Research and Sponsored Programs
Student Records and Registration

Name of Faculty Member*

Department or School*

Please select the appropriate college dean's office to receive a copy.* College of Sciences and Arts
College of Engineering
College of Forest Resources and Environmental Science
College of Business
College of Computing

Select separation type.* Resignation
Retirement
Other

For a resignation, an email should be sent directly to Equal Opportunity Compliance and Title IX (eocompliance@mtu.edu) with the reason for separation.

Expected Date of Departure*

Your Name (person completing the form)*

Your Email*