Fillable Southern State Community College - Release Time Request Form

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Southern State Community College - Release Time Request Form

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Academic Forms
Revised 8/2019
RELEASE TIME REQUEST FORM
Name __________________________________________________ Date of Request ____________________________________
Hours of Release Time Requested ___________________________________________________________________________
Release time hours are multiplied by 2 to approximate work hours per week (e.g. 2 hrs release = 4hrs/week)
Semester in which release time is being requested _______________________________________________________
A new form is required for each semester in which release time is requested.
Please describe the purpose of the release time being requested and how it relates to the Southern State
Strategic Plan, professional initiatives, assignments beyond duties included in one’s job description, or
special assignment:
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Identify the specific outcomes, responsibilities, objectives, tasks, or other deliverables that can be measured:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
By signing this request I acknowledge that I am requesting release from my contractually required load hours
to complete the work described above and that I may be required to submit progress reports related to the
measurable outcomes I have identified:
___
____________________________________________________________________________ _____________________________
Faculty Signature Date
Approval from the respective Dean and the Vice President of Academic Affairs is required for a mutually
agreed up
on Release Time assignment
________________________________________________________________________________ _____________________________
Dean’s Approval Date
________________________________________________________________________________ _____________________________
Vice President of Academic Affairs Approval Date
** Please contact the SSCC Webmaster at webmaster@sscc.edu for suggested updates or changes to this form **
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Southern State Community College - Release Time Request Form

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Completed 4 May 2020

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