Fillable CSU fresno sabbatical leave application

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CSU fresno sabbatical leave application

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____________________________________________________________
CALIFORNIA STATE UNIVERSITY, FRESNO
SABBATICAL LEAVE & DIFFERENCE IN PAY
LEAVE REQUEST FORM ________________ ACADEMIC YEAR
Applicable Policies: CBA Article 27 Sabbatical Leaves
CBA Article 28 Difference in Pay Leaves
Campus Policy: Policy
on Faculty Leaves of Absence (APM 360)
I understand the terms and conditions for a sabbatical / difference in pay leave as detailed in the
Collective Bargaining Agreement and the campus Policy on Faculty Leaves of Absence. I agree to
abide by these terms and conditions in return for approval of the leave.
1. Name
2. Address ______________________________________________________________________
3.
Rank: Professor
Associate Professor
Assistant Professor
Full Time Lecturer
4. Date of Full-Time Appointment Fall __________ Spring _______
5. Years of service (include current year and any service credit) _____________________
6. Date of last sabbatical leave _____________________________
A copy of the report from the last sabbatical or difference in pay leave, if any, shall be attached to the proposal. (APM 361)
7. Date of last difference-in-pay leave _________________________
A copy of the report from the last sabbatical or difference in pay leave, if any, shall be attached to the proposal. (APM 361)
(a) SABBATICAL, One semester at full pay Fall 20____ Spring 20___
8. PAID LEAVE REQUESTED. (Check the appropriate category.)
(b) SABBATICAL, Two semesters at half pay Academic Year ___________
(c) DIFFERENCE IN PAY Academic Year ___________
Difference in pay leaves are normally for two semesters at the difference between your current nine month salary
and the minimum for the Instructor rank. Difference in pay leaves may also be a single semester.
FOR EACH SEMESTER TAKEN FOR A SABBATICAL LEAVE OR A DIFFERENCE IN PAY LEAVE,
THE APPLICANT IS REQUIRED TO RENDER EQUIVALENT FULL TIME SERVICE ON THE
CAMPUS AFTER COMPLETION OF THE LEAVE.
(PLEASE COMPLETE THE REVERSE SIDE)
APS: Sabbatical Leave Request Form (side one) Revised 11/01
____________________________________________________________
Pursuant to CSU policy, final approval of a sabbatical leave or a difference in pay leave shall not be granted until the applicant has filed a
suitable bond or an accepted statement of assets (not including PERS holdings) and/or a promissory note that is individually or collectively
at least equal to the amount of salary paid during the leave.
Should the leave be approved, I will do one of the following to meet this requirement.
Check the appropriate box(es)
_____ Provide an accepted bond settlement,
_____ Provide a list of my assets equal to my salary during my leave
_____ Provide a completed and signed Promissory Note.
SHOULD A LEAVE BE GRANTED, THIS APPLICATION, INCLUDING A COPY OF THE LEAVE
PROPOSAL, AND ITS ATTACHMENTS WILL BE PLACED IN YOUR OPEN PERSONNEL FILE.
I understand all the terms and conditions of this leave. I agree that while on this paid leave that I may not
accept additional and/or outside employment without receiving the prior approval of the Provost.
I understand that if I am taking an Academic Year Sabbatical or a Difference in Pay leave that I will NOT
be credited for a full year of service credit for purposes of retirement (PERS). I understand that I should
discuss the implications of this leave with the Benefits Office immediately upon my return from the leave.
Contact Benefits at 278-2032.
By my signature, I agree to adhere to the terms and conditions of the leave as noted in Article 27 (Sabbatical
leaves) or Article 28 (Difference in pay leaves) of the CBA, as appropriate, as well as the campus Policy on
Faculty Leaves of Absence (APM 360). Furthermore, I attest to the truthfulness and accuracy of my
application, including any attachments and/or documents submitted by me as part of my application.
Signature of Applicant Date
APS: Sabbatical Leave Request Form (side two) Revised 02/05/2019
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CSU fresno sabbatical leave application

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Completed 25 December 2019

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