Faculty Single Semester Leave
1. Complete Faculty Single Semester Leave Form and submit to department head.
2. If request is recommended by department head/chair, submit form to college screening committee.
3. Forward request, with priority ranking, from college screening committee to the Dean/Vice Chancellor.
4. If request is approved, provide signed copies to:
Dean/Vice Chancellor Department Employee Benefits
5. Enter approved leave information into PeopleSoft prior to the beginning of the single semester leave.
For
more information, see Board of Regents Policy: Employee Development, Education, and Training at
http://regents.umn.edu/sites/regents.umn.edu/files/policies/Emp
loyee_Develop_Educ_Training.pdf and the University Administrative
Policy: Faculty Development Leaves at http://policy.umn.edu/hr/facleaves.
Name Empl ID
Rank or Title Job Code
DeptID Entity College
Start Date of Requested Leave End Date of Requested Leave
Annual Full-Time Base Salary Basic Term of Appointment 9 to 10 mo. term paid over 12?
Yes No
Appointment Type
Probationary
Tenured
Clinical Scholar
Multiple-Year Contract
Annually Renewable
Yearly Appt – Med School
Project to be Conducted During Le
ave - attach additional information if necessary
Title of Project: Institution or Location where project would be conducted:
Nature and significance of project in terms of scientific, scholarly, or artistic value, and/or practical application:
Present state of knowledge or accomplishment on subject – General status:
Present state of knowledge or accomplishment on subject – Your background or activities in this area:
Description of research design or project plan (include specific information on approach to the project, methods to be used, potential
results, and why the Single Semester Leave will facilitate this activity):
1 of 2
Route this form to:
See Routing
Instructions Below
U Wide Form
UM 21
Rev: 06/16
Applicant Information
