APPLICATION FOR SABBATICAL LEAVE
UNIVERSITY OF HAWAI‘I AT HILO
Applicant _____________________________ Title _______________________ Rank ________________
College ______________________________ Division ____________________ Dept ________________
Period of sabbatical leave requested: Date of initial hire at the
From _______________ To ______________ University of Hawai‘i: __________________
Are you tenured? Yes No
List all breaks in service and all periods of less than full-time service:
Dates of last sabbatical leave: From _______________ To __________________
Attach Separate Sheets(s) Showing:
1. An outline of the project, research of study program proposed.
2. Statement of financial remuneration expected from non-University of Hawai‘i sources.
Statement of Understanding and Compliance
I understand that sabbatical leave is granted in in accordance with University rules, and that should I be
authorized such leave, I shall carry out my sabbatical plan and submit a written report on my sabbatical
activities. I also understand that I am required to return to the University of Hawai‘i for at least one year of
service upon completion of the sabbatical leave or upon completion of any other approved leave granted in
conjunction with the sabbatical leave. I agree that if I do not return or do not fulfill my return service
obligation, I shall reimburse the University all compensation received from the University during the sabbatical
leave period.
Applicant’s Signature __________________________________________ Date ___________________
RECOMMENDATION
Approve Disapprove Signature Date
Department Chair ________________________________ ___________
Division Chair ________________________________ ___________
Dean ________________________________ ___________
Human Resources (review only) ________________________________ ___________
Vice Chancellor _________________________________ ___________
APPROVED / DISAPPROVED Chancellor ___________________________________ ____________
*Attach explanation of how applicant’s duties will be covered. If disapproval is recommended, attach explanation also.
6/25/13
