Fillable LOA UNIVERSITY SYSTEM OF GEORGIA

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LOA UNIVERSITY SYSTEM OF GEORGIA

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U.S.A. forms for West Georgia College

BROWSE WEST GEORGIA COLLEGE FORMS

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UNIVERSITY SYSTEM OF GEORGIA
Recommendation for
Leave of Absence from
Name of Institution
Name
ADP ID
Date Employed
Rank or Title College or Division Department
Current Salary Contract Type Position Number No. Semesters Service to Date
Period and type of leaves granted previously
Effective date and period of leave now recommended
Purpose of leave and name of institution if for advanced study
State funds: $ ; Federal funds $ ; Other $
AGREEMENT: I, the undersigned petitioner for leave, do agree that I will return the full amount of
compensation received from the institution while on leave if I should not return to the institution for at least one
year of service after the termination of my leave.
Leave recommended by:
Department Chair Date
Dean Date
Provost Date
President Date
All awards of leave are subject to the availability of funds for the academic year.
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LOA UNIVERSITY SYSTEM OF GEORGIA

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Completed 20 November 2019

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