SABBATICAL LEAVE APPLICATION

Date	Click here to enter text.	Name of Applicant	Click here to enter text.

Initial Date of full-time employment with Athens State University Click here to enter text.

Sabbatical leave requested for	☐Full academic year	☒Fall 20____	☒Spring 20___

(Fall 20____and Spr20___)

I have served, continuously, for six (6) or more

full-time academic years at Athens State University	☐ YES	☐ NO

I have taken previous sabbatical leave as follows: [list semester(s) and year]

First sabbatical	Click here to enter text.	Second sabbatical	Click here to enter text.

Third sabbatical	Click here to enter text.	Other sabbatical	Click here to enter text.

Please answer the following:

1.	What do you plan to accomplish with your sabbatical? List specific expected outcomes.

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2.	How do you anticipate that your sabbatical plan will make you a better educator? How will your

Sabbatical plan improve your teaching and student learning?

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3.	What activities will help you meet the anticipated accomplishments of your sabbatical plan?

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4.	What is your anticipated timetable for accomplishing the activities of your plan? (by semester)

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5.	What documentation will you provide for your activities and the completion of your sabbatical

plan when you write your sabbatical report?

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6.	What are the arrangements to cover your instructional responsibilities, supervision of advisees, and other duties for which you are responsible?

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7.	What is your plan for disseminating the results of your sabbatical to the University Community?

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8.	Detail any anticipated/known expenses required to complete your sabbatical plan.

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This sabbatical plan, which I will complete, will be of mutual benefit to the University and to me.

I further understand that upon return from the sabbatical leave, I will submit a Post-Sabbatical Leave report, which will document how I have accomplished this plan.

________________________________________________________	_____________________________________

Signature of Applicant	Date

SABBATICAL LEAVE APPLICATION APPROVAL

Approval #1

Sabbatical plan meets the purpose and criteria for a sabbatical leave (unconditional approval)

Sabbatical plan is approved with the following conditions:

Sabbatical plan is not approved for the following reasons:

_________________________________________________________________	_______________________________

Signature of Dean	Date

Approval #2

Sabbatical plan meets the purpose and criteria for a sabbatical leave (unconditional approval)

Sabbatical plan is approved with the following conditions:

Sabbatical plan is not approved for the following reasons:

__________________________________________________________________	_______________________________

Signature of Provost/Vice President for Academic Affairs	Date

Approval #3

Sabbatical plan meets the purpose and criteria for a sabbatical leave (unconditional approval)

Sabbatical plan is approved with the following conditions:

Sabbatical plan is not approved for the following reasons:

__________________________________________________________________	_______________________________

Signature of Sabbatical Review Committee Chair	Date

Approval #4

Sabbatical plan meets the purpose and criteria for a sabbatical leave (unconditional approval)

Sabbatical plan is approved with the following conditions:

Sabbatical plan is not approved for the following reasons:

__________________________________________________________________	_______________________________

Signature of University President	Date