PLEASE COMPLETE IN DUPLICATE
APPLICATION FOR LEAVE
RETURN to the Office of the Vice Provost and Dean for Graduate Studies, 116 McMahon Hall,
BEFORE DECEMBER 15, preceding the academic year for which leave is requested.
1. Name School
Rank Department
Employee ID Date of First Faculty Appointment
Date of Birth Date of Appt. to Present Rank
2. Type of leave requested: Sabbatical for one semester at full salary
Sabbatical for two semesters at one-half salary
Leave of absence without salary
Other (specify)
3. Period of Leave Request: From to
4. Dates of Previous Leaves: Sabbatical
Other
5. Applicant has attached a statement of purpose indicating relation of leave to applicant’s academic
development and the University’s goals and providing additional information deemed relevant.
6. Applicant for sabbatical leave agrees to use the period of leave for research and publication advancing
knowledge; not to engage in gainful employment while on leave; and on return to academic service, to
submit to the Provost, with a copy to the Dean, a report of activities while on leave.
7. Applicant has made (or will make) reasonable provisions for continuation of the direction of dissertations
during the proposed leave period.
Date Signature of Applicant
8. I/We endorse this request for leave (a) as justified by its anticipated contribution to the applicant’s academic
development and the University’s intended purposes and (b) as feasible in view of the obligations of the
Department and/or School.
Date Signature of Chair
Date Signature of Dean
__________________________________________________________________________________________
Recommended
Not Recommended Date
Vice Provost for Research Support and
Dean of Assessment
__________________________________________________________________________________________
Approved
Not Approved Date Provost
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