Form J
Name_______________________ Date of last sabbatical________________________
Department__________________ Year of initial employment____________________
Date _______________________ Date of LWOS______________________________
I prefer a sabbatical assignment for: ____Fall ____Spring ____Year
(100% salary) (50% salary)
Please number in order of preference
I. General Purpose of the Academic Sabbatical Assignment
(please check the most appropriate)
___Research/Creative Activity ___ Updating of Professional Knowledge
___Acquiring New Professional Knowledge ___ Enhancement of Teaching Performance
Please attach 1-2 paragraph responses for each of the following headings. The questions provided are
intended solely to clarify the information desired for that heading; not all questions will be appropriate for
all proposed sabbatical activities.
II. Specific Purpose (What specific activity or project will be undertaken? What is the expected
outcome of the sabbatical assignment?)
III. Background Statement (Why is the proposed activity or project of interest to you and to others?
What rationale or justification is there for pursuing the proposed activity or project?)
IV. Outline of Activity/Project (What stages, activities, or procedures need to be accomplished to
achieve the desired outcome? What is the timeline for completing the proposed activity or
V. Anticipated Benefits (How will your students, the University, and/or the scholarly or
professional community benefit from the proposed activity or project? How will the results or
accomplishments of the sabbatical assignment be disseminated? How does the proposed activity
or project contribute to the mission of the University?)
YES NO (circle one)
If yes, indicate term approved_________________________
___________________________ ___________________________
Chair Dean
___________ ___________
date date
Please note that the completed application will be placed in the employee's personnel file.
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