Teachers Retirement System of Georgia

All required fields are preceded with an *.

*	Your Name:
*	Your Date of Birth:	(mm/dd/yyyy)
	Beneficiary's Date of Birth:	(mm/dd/yyyy)
*	Estimated Date of Retirement:	(mm/yyyy)
*	Estimated Years of Service:	Year(s) Month(s)
	Total Accrued Sick Days¹:
*	Salary (2 highest consecutive years):	$(year one)
		$(year two)

¹ Sick days you have earned, not used, and for which you have not been paid by your employer. You must have at least 60 days, and the maximum allowable accumulation is 1.25 days of sick leave per month of service. Total service credit cannot exceed 40 years. Documentation will be required from your employer(s) verifying your sick leave.