ADMINISTRATIVE SABBATICAL LEAVE REQUEST FORM
SUM FALL WTR SPR
NAME (Last, First, Middle Initial) DATE PREPARED
Please read instructions prior to completing the request and submit all information for consideration in one packet. You must
include a letter of support from 1) immediate supervisor and 2) appropriate Presidential Advisory Team (PAT) member identifying
budget requests to support the Sabbatical, how the employee job assignment will be covered, and if another employee will work
out of class to complete some or all of the work assignment.
DEADLINE: The completed request must be submitted by the 4th Monday of November, 4:30 p.m. to the President of COCC.
The President will notify applicants by January 31 of the year prior to the sabbatical request if the proposal has presidential
Give a brief statement of how this sabbatical support COCC's Strategic Plan themes and objectives?
ACADEMIC YEAR SERVICES
BEGIN DATE RETURN DATE
Give a brief statement of how this sabbatical contributes to your professional expertise for professional growth and/or meets
the goals identified on your Annual Evlauation.
Abstract, including top three completeion goals:
IS THIS AN EXTENSION OF A PREVIOUS LEAVE?