Dear _____________________________,                             DATE

Before leaving the department at the end of your appointment, please complete this form with initials from individuals stated below, and return to Ms. Judy Ludwig in room 122.

_____1. Return any Chemistry Dept. room keys to Ms. Mary Kosh in room 119 of the Chemistry Buidling. (Any ILSB keys should be returned to Ed Janousek, Facilities Coordinator of the ILSB)

_____2. Return your A&M faculty and staff ID card to Ms. Judy Ludwig in room 122. Building access will be terminated on your departure date.

_____3. A Health/Dental Coverage Continuation Form as required under COBRA will be prepared for you if applicable.

_____4. Return your University Issued CONCUR Travel Card to Ms. Angie Stickley in room 119.

_____5. Your TAMU email address will be terminated on your employment termination end date. to ensure continuance of receiving email see Chemistry's Help Desk in room 251. Backup your Google Drive.

_____6. Terminate your password on the Chemistry Department's NMR Spectrometers with Mr. Greg Wiley, room 1325.

_____7. Return Stockroom Authorization Card and terminate your name from all accounts and projects in the Chemistry Department Research Stockroom with Mr. Dennis Havemann, Room 014.

_____8. Properly label and tag for disposal all containers and waste chemicals that are not immediately needed by other members of your research group after your departure. Take containers to Chemical Waste Disposal, Room 001G. (Requires faculty advisor/Department Head signature.) __________________________

_____9. Pay any telephone and Xerox bills that may be outstanding.

_____10. Return all "loaned" and borrowed equipment and tools. See Ms. Mary Kosh in room 119.

_____11. Notify the Emergency Response Team Floor Personnel Coordinator of your departure date.

_____12. If you are an internal visitor holding j-1 or H1B status, what date did you report to ISFS as your "Last Day of Employment/Visit."? ____________________ complete and return to Ms. Ludwig the attached "Departure Notification Form".

_____13. Please be aware of the University Sick Leave Program. Terminating employees, who will lose their sick leave, are encouraged to donate time to the pool. Please see Ms. Ludwig if you would like to help others by donating your sick leave time.

_____14. Return parking permit to Transportation Services, Room 108, Koldus Buidling.

_____15. Ensure arrangements are complete with Ms. Ludwig or Ms. Mary Morgan in Room 121 regarding distribution of your last paycheck and lump sum vacation payment, if any. Ensure address changes are updated on Single Sign On HR Connect

Thanks for your cooperation.

Ronald G. Carter
Assistant Department Head

Signature:________________________________________

XC: Supervisor