Name ________________________________________________________________________
Employee ID Number_____________________________ Date _________________________
Permanent Mailing Address _____________________________________________________
In accordance with Northeastern Oklahoma A&M College regulations governing
Sabbatical Leaves of Absence, which I have read in the Faculty Handbook, I hereby apply for
such leave from _______________ to ________________ at either 50% __ or 100%__ of the
salary provided to me by the College.
I have been a member of the faculty or staff of Northeastern Oklahoma A&M College for
____ years, holding positions as follows for the years indicated.
___________________________________________________________ __________________
___________________________________________________________ __________________
___________________________________________________________ __________________
I have not been granted a similar leave of absence within the past _____________ years.
This application is accompanied by _______ pages of attachments, including:
1) a detailed description of the nature of the activity to be conducted during the
sabbatical leave, where the activity will take place, and how it will benefit
Northeastern Oklahoma A&M College. (I understand any significant change in these
plans must be reported immediately to my supervisor and receive approval from
appropriate administrators or the leave will be terminated.)
2) one copy of application form and reports on previous sabbatical leaves I have been
granted by Northeastern Oklahoma A&M College.
3) a summary of other leaves granted to me by Northeastern Oklahoma A&M College
for more than one month; and
4) a statement from my supervisor explaining arrangements to take care of my regular
duties during my absence.
DATE _____________________ SIGNATURE______________________________
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In consideration of receiving the aforesaid Sabbatical Leave, I hereby agree: 1) to report
in writing to my supervisor at the end of each semester of my leave (or more often if requested)
as to the manner in which the leave was employed, and if I fail to do so Northeastern Oklahoma
A&M College may terminate the leave and/or deny future leave application; 2) to withdraw from
all departmental, college, and university committees for the duration of my leave, unless
otherwise requested by my supervisor; and 3) to remain in the service of Northeastern Oklahoma
A&M College at not less than my present salary for one year after the expiration of my leave,
unless prevented by death or total disability.
As further consideration for the aforesaid sabbatical leave and the compensation received
by me from Northeastern Oklahoma A&M College during said leave, I hereby promise to pay to
Northeastern Oklahoma A&M College on demand, all sums and compensation paid to me and on
my behalf by Northeastern Oklahoma A&M College during my sabbatical leave in the event I
fail to return to Northeastern Oklahoma A&M College after said leave ends. In the event I return
to Northeastern Oklahoma A&M College as required after the sabbatical leave, but leave prior to
the expiration of one year from the date thereof, the amount so due and payable to Northeastern
Oklahoma A&M College on demand shall be a pro rata amount of all compensation and sums
paid to me and on my behalf during my sabbatical leave based upon the proportion the unserved
service months bear to the total required service months. In the event suit is commenced to
enforce payment of the obligations hereunder, I agree to pay the cost of such litigation including
a reasonable attorney’s fee.
DATE _____________________ SIGNATURE _____________________________
_____________________________________ ____________________________________
Department Chair Date Vice President for Academic Affairs Date
or Administrative Officer
_________________________________________ ____________________________________
President Date Payroll Office Date
_________________________________________ ____________________________________
A&M Board Approval Date Payroll Authorization Number
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