Fill - Free fillable APPLICATION FOR SABBATICAL LEAVE FORM Cover Sheet (San Diego Mesa College) PDF form

San Diego Community College District

3375 Camino del Rio South

San Diego CA 92108-3883

APPLICATION FOR SABBATICAL LEAVE FORM

Cover Sheet

Name

ID #

College/Center Assignment

Date

Please answer the following questions:

1. Have you ever taken a sabbatical leave? Yes No

My sabbatical Abstract and Plan are attached.

3. Have you been employed in this district for six (6) consecutive years? Yes No

THE DUE DATE FOR ALL SABBATICAL LEAVES IS THE THIRD FRIDAY IN FEBRUARY (See Part V of Leave Procedures)

If so, when?

2. Have you ever taken any other kind of long-term leave? Yes No

See reverse side for plan and abstract format. Refer to SDCCD Sabbatical Leave Procedure for specific

information. This document is available online. A sample is included.

Sabbatical Leave Options and Amount of Compensation Requested

If so, when?

In accordance with the applicable provisions of the California Education Code and the Policies and Procedures of the San Diego

Community College District, a sabbatical leave is requested for the following period of the 20 - 20 school year;

10-Month Employees

11/12-Month Employees

Full fiscal year (50%)

First six months of the Fiscal Year (100%)

Two months in summer for three

Quarter (indicate 1st, 2nd, 3rd, or 4th)

Second six months of the Fiscal Year (100%)

Academic Coursework

Teaching, Learning and Appropriate Instructional and Student Services Activity

Research

Retraining

Full academic year (50%)

Fall semester only (100%)

Spring semester only (100%)

Two non-sequential semesters

within a 36-month period (50%)

( semester, 20 -20 )

and semester, 20 -20 )

consecutive summers (100%)

Two nonconsecutive quarters (100%)

Purpose of Leave

Method of Compensation

The employee requests that sabbatical leave compensation be paid under the plan checked below:

Option 1. If the leave is for a period of one year, the faculty member may receive compensation in two equal

installments at the end of the first and second year of service rendered in the District following return from leave. If

the leave is for a period less than one year, the faculty member may receive the total compensation at the end of the

first year of service rendered in the District following return from leave.

Option 2. Regardless of the length of leave, the faculty member may receive compensation in the same manner as if

he/she had remained in active service.

Signature of Applicant

DateSignature of Applicant

9/08

Print Form

9/08

(Application for Sabbatical Leave)

 Please number all pages in consecutive order (so that the committee can be sure that there are no pages missing).

 Applicants, chairs, and deans should be careful not to list applicant's name anywhere on the application except on

the cover page and the signature sheet.

 Please be advised that all units taken during a Sabbatical Leave may be used for salary advancement.

Abstract:

Provide an abstract summarizing the description of your proposed leave plan in a paragraph of about

100 words. This part of your application will become part of the Board Docket. Please include the

following information as part of the abstract:

1. Need for the Professional Growth - describe the purpose of the leave.

2. Sabbatical Activities - describe what you plan to do.

3. Anticipated Outcomes - describe the primary outcome; instructor and classroom teaching

outcomes; professional/faculty relationship outcome; student outcomes.

4. Means of Measurement - describe what evidence you will submit to demonstrate

achievement of your outcomes.

5. Benefit to District

Plan:

Provide a full description of the proposed sabbatical leave including the following

information in your sabbatical plan. It is recommended that you include a separate section for

items 1-6 listed below. As you prepare this plan, it is also strongly recommended that you

consult with the Department Chair/Supervisor and/or School Dean/Manager prior to the third

Friday in February to address any issues or to provide additional information or clarification

regarding the proposed plan. You may also consult with any member of your college's

professional growth/development committee.

1. Need for Sabbatical - how does your plan meet the need for professional growth and

development as well as benefits to the students, colleagues and college?

2. Description of Overall Plan - a detailed course of action that is consistent with the

statement of purpose and nature of the leave.

3. Objectives - What do you plan to accomplish and how will you measure it?

4. Evidence of Completion - reports, video, transcripts.

5. Relevancy to Current/New Assignment and Improvement of Student Learning

6. Timeline - What is the timeline for accomplishing your objectives? This timeline

must take place only during the semester of your proposed sabbatical leave.

9/08

San Diego Community College District

3375 Camino del Rio South

San Diego CA 92108-3883

(Application for Sabbatical Leave)

Recommendations and Signatures:

Department Chair Recommendation: