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Sabbatical (Long-Term, Unpaid) - Application Form

(Faculty Professional Development Unpaid Long-Term Leave)

Note: Use this as a template for your application... you will need to expand on your own those sections requiring extensive text and explanations

***Please review guidelines before completing this application***

Outline:

Part I      Applicant Information
Part II     Leave Information (information may be presented on paper, video or cassette tape)
Part III    Division Chair Impact Statement

Directions:

I. Applicant Information

II. Leave Information:

1. Describe your plan in detail. The committee would like to know what you expect to accomplish. (Remember to cover who, what, where, when, why, and how.)

    

   How will this activity contribute to your growth as a professional person?

    

   How is this activity valuable to the college?

    

2. In addition to a written report of your activities, it is expected that you will share your experience with other faculty. What format might this take, and how can the committee assist you?

III. Division Chair Impact Statement

Note: the leave request may be submitted even if there may be a negative impact to the Division. The committee would like to be aware of this up front, so that steps may be taken to facilitate negotiation and/or problem solving.

Division Chair: Please indicate your detailed plan for a replacement instructor and include estimated costs to do this.

Please provide a written statement of the impact to your division if this applicant is granted the proposed leave.

Estimated replacement cost: Wage $                           OPE $ Total $

Division Chair signature: ____________________________         Date: ____________

For Committee Use: