Fillable CSU Fresno Sabbatical Review Form

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CSU Fresno Sabbatical Review Form

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CALIFORNIA STATE UNIVERSITY, FRESNO
Sabbatical Leave & Difference in Pay Review Form
SECTION I: GENERAL INFORMATION
Faculty Name:________________________________________________________
Department:__________________________________________________________
College/School:___________________________________________________
Date of Application: __________________
Is the Department Chair submitting a separate recommendation (Check One): ____Yes ____No
SECTION II: DEPARTMENTAL COMMITTEE INFORMATION
Action Recommended by Department Peer Review Committee {Include Vote In ( )}
Note: Each Committee Member Votes for Only One category.
(______) Not Recommended (_____) Recommended
Departmental
Ranking (sabbaticals only) _________
Names and signatures of all Department committee members (list all members and indicate the individual
designated as chair [and department chair if not making an independent recommendation]. Signatures indicate
that the above recommendation represents the Department Peer Review Committee's action):
Signature Date
Signature Date
Signature Date
Signature Date
Signature Date
Signature Date
Signature Date
(Please Continue To The Next Page)
Member Name
Member Name
Member Name
Member Name
Member Name
Member Name
Member Name
________________________________________________________________________
PAGE 2 Applicant Name__________________________________
SABBATICAL / DIFFERENCE IN PAY REVIEW FORM
SECTION III: DEPARTMENT CHAIR INFORMATION
Note: this section is to be completed only if the department chair is making a separate
recommendation.
Action Recommended by Department Chair.
Departmental
(_____) Recommended (______) Not Recommended Ranking (sabbaticals only) _________
Signature indicates that the above represents the Department Chair's action.
SIGNATURE DATE
I HAVE RECEIVED A COPY OF THE ABOVE INFORMATION. I HAVE HAD AN
OPPORTUNITY TO DISCSS THE RECOMMENDATION(S) WITH THE DEPARTMENT
CHAIR. I AM AWARE OF MY RIGHT TO APPEAL THIS RECOMMENDATION TO THE
COLLEGE/SCHOOL PEER REVIEW COMMITTEE.
FACULTY SIGNATURE DATE
(Please Continue to the Next Page)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______
PAGE 3 Faculty Name_______________________________
SABBATICAL AND DIFFERENCE IN PAY REVIEW FORM
SECTION IV: COLLEGE/ SCHOOL COMMITTEE INFORMATION
Action Recommended by College/School Peer Review Committee {Include Vote In ( )}
Note: Each Committee Member Votes for Only One category.
(_____) Recommended (______) Not Recommended Ranking (sabbaticals only) _________
Names and signatures of all College/School committee members (list all members and indicate the individual
designated as chair of the committee). Signatures indicate that the above recommendation represents the
College/School Peer Review Committee's Action.
SIGNATURE DATE
SIGNATURE DATE
SIGNATURE DATE
SIGNATURE DATE
SIGNATURE DATE
SIGNATURE DATE
SIGNATURE DATE
SIGNATURE DATE
I HAVE RECEIVED A COPY OF THE ABOVE INFORMATION. I HAVE HAD AN OPPORTUNITY TO DISCSS THE
RECOMMENDATION(S) WITH THE PEER REVIEW COMMITTEE CHAIR. I AM AWARE OF MY RIGHT TO
APPEAL THIS RECOMMENDATION TO THE DEAN.
FACULTY SIGNATURE DATE
________________________________________________________________________
_______
(Please Continue to the Next Page)
PAGE 4 Faculty Name_______________________________
SABBATICAL AND DIFFERENCE IN PAY REVIEW FORM
SECTION V: DEAN DECISION
ACTION TAKEN BY DEAN (CHECK ONE):
__________APPROVED ____________DISAPPROVED
Signature indicates that the above represents the Dean's action.
DEAN SIGNATURE DATE
I HAVE RECEIVED A COPY OF THE ABOVE INFORMATION. I HAVE HAD AN
OPPORTUNITY TO DISCSS THE RECOMMENDATION(S) WITH THE DEAN.. I AM AWARE
OF MY RIGHT TO APPEAL THIS DECISION TO THE PROVOST AND VICE PRESIDENT
FOR ACADEMIC AFFAIRS.
FACULTY SIGNATURE DATE
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CSU Fresno Sabbatical Review Form

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Completed 25 December 2019

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