Early Retirement Incentive Workshop Reservation Form

Please provide the following information and return the form to the Office of Human Resources no later than May 1, 2002. The following information will be submitted to the Division of Pension and Benefits to prepare the individual estimate of retirement benefits prior to the early retirement incentive workshop.

Name of Employee __________________________________________________

Current address _____________________________________________________

__________________________________________________________________

Home Telephone Number __________________ Work Extension _____________

E-mail Address _____________________________________________________

Department Location _________________________________________________

Anticipated Retirement Date: ____May 1, 2002 ____June 1, 2002 ____July 1, 2002

Name of Beneficiary ________________________Date of Birth_______________

Employee Signature ____________________________ Date _________________

Early Retirement Incentive Workshop at Kean University

Monday, May 13, 2002

University Center, Room 337A and B

9:00 a.m. —12:00 p.m.

1:00 p.m. --- 4:00 p.m.

Please bring with you to the workshop the following items:

1. Early retirement package mailed to you by the Division of Pensions and Benefits.

2. A photocopy of proof of age documents for you and your beneficiary.

3. If you and your spouse are currently enrollment in Medicare A, you and your spouse should apply for Medicare Part B at the Social Security Administration. If your retirement date is on July 1, 2002, your Medicare Part B effective date should be August 1, 2002.

Should you need further information, please contact the Office of Human Resources at (908) 527-2150.