APPLICATION FOR SABBATICAL LEAVE
TO BE COMPLETED BY THE APPLICANT:
Applicant Name:
e:
EmployeTitl e ID:
Department:
BSU E-mail:
Campus Mail Stop:
College/School:
Date of Initial BSU Faculty Tenure Appointment:
Date of Tenure Award:
Dates of previous sabbatical leave(s) and leave(s) without pay:
Period of sabbatical leave covered by application (enter YY)
Fall 20 Spr 20 Full Year 20 Other
Required Application Material (Checklist):
☐ Application for Sabbatical Leave
(this form)
☐ Abstract of Project
(50 words max)
☐ Detailed Statement of Leave Plans
(6 pages max, see BSU Policy #4400 II.C.3 for details)
☐ Two Peer Review Letters
(one letter from off-campus)
☐ Curriculum Vitae
(6 pages max)
☐ Chair Evaluation Letter
(added by Chair)
☐ Statement of intention to return (see below)
RETURN COMMITMENT AGREEMENT (TO BE COMPLETED BY THE APPLICANT):
I hereby agree to return to and to work for Boise State University as a full-time faculty member for the period of at least one (1) year following
completion of the sabbatical leave. I acknowledge that, pursuant to BSU Policy #4400, my failure to comply with the agreement shall constitute an
obligation to repay BSU any remuneration received from BSU during the period of leave.
Date Applicant Name (print) Signature
CHAIR APPROVAL: ☐ Yes ☐ No
Instructional Replacement Costs Requested: $___________________________
Date Department Chair Name (print) Signature
DEAN APPROVAL:
☐ Yes ☐ No
Date Dean Name (print) Signature
PROVOST APPROVAL:
☐ Yes ☐ No
Instructional Replacement Costs Approved: $___________________________
Tony Roark, PhD
Date Provost Name (print) Signature
One original paper copy of your application that includes all contents listed in BSU Policy #4400, Section II C, must be forwarded to
your Department Chair on or before December 1st.
Chair will attach his/her evaluation letter to the original application and forward to appropriate dean on or before December 31st.
Dean will approve and forward the chair’s evaluation letter with the original application to the Office of the Provost and Vice
President of Academic Affairs on or before January 15th. The Office of the Provost will forward all applications and evaluation
letters to the Sabbatical Committee.
Rev. 11/27/18
