Form L Name_______________________________________
APPLICATION FOR LWOS (Leave Without Salary)
Tenured/Tenured Track Faculty Department__________________________________
Office of VPAA (8/13/2020)
Eastern Illinois University Date of Initial EIU Appointment_________________
TIME LEAVE REQUESTED Tenure: Yes ____
No
Date of Tenure:_______________
(1=first choice, 2=second choice)
Fall Semester
I desire that time spent on leave
Spring Semester
count not count toward probationary period.
Academic Year
Other (describe)
Attach 1-2 page specific description of planned
leave activities and accomplishments.
Purpose: Personal Research Advanced Study Professional Development Public Service
Date of Application Signature of Applicant_____________________________________________
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CHAIRPERSON RECOMMENDATION
Recommend disapproval Recommend approval for: Recommend Replacement:
Reason (if leave plan unacceptable): Fall Semester Yes No
Spring Semester If Yes, Chair must attach
Academic Year statement of justification for
Other (describe) replacement.
Date of Recommendation Signature of Chairperson_________________________________________
---------
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DEAN RECOMMENDATION
Recommend disapproval Recommend approval for: Recommend Replacement:
Reason (if leave plan unacceptable): Fall Semester Yes No
Spring Semester
Academic Year
Other (describe)
Date of Recommendation Signature of Dean______________________________________________
---------
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VPAA RECOMMENDATION
Recommend disapproval Recommend approval for: Recommend Replacement:
Reason (if leave plan unacceptable): Fall Semester Yes No
Spring Semester
Academic Year
Other (describe)
LWOS time to count
not count toward probationary period.
LWOS time to count
not count toward promotion period.
Date of Recommendation Signature of VPAA______________________________________________
--------------------------------------------------------------------------------------------------------------------------------------------
ACTION BY PRESIDENT: Approve LWOS: yes no
Eligible for state insurance: Yes No (mark one)
Please note that the completed application will be placed in the employee's personnel file.
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