I.) EVALUATION BY DEPARTMENT CHAIR / HEAD
I. A.) How will this leave enhance the ability of the applicant to meet his/her responsibilities
within the LSU System?
I.B.) What is your overall evaluation of this request?
Recommended with conditions
(state conditions in Section I.C)
Do not recommend
(state reasons in Section I.C)
I.C.) Comments (from Section I.B.)
I.D.) How do you rate this
request among all other
requests from your department?
I.E.) Applicant’s current
I.F.) Applicant’s current
teaching credit hours:
(Numeric Rank) (Numeric Rank)
I.G.) Is replacement teaching needed?
I.H.) Is a replacement needed for other
Department Chair/Head Signature: __ Date: ____
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