ࡱ> AC@y m6bjbj =<{{z@@@@@TTT8,4T($$$j}T,$Y VQ@@@$$ijjjR@$@$jjjj$ԣ"o&"j0j H jj @~`LI6j,)H"  : INDIANA UNIVERSITY BLOOMINGTON CAMPUS APPLICATION FOR SABBATICAL LEAVE Name: School: _______________________ Academic Title: Dept: ________________________ Effective date of initial appointment as a full-time member of the faculty of Indiana University: _________________________ Periods of previous sabbatical leave: __________________________________________________ Periods of leave of absence With Pay Without Pay other than sabbatical leaves: _______________________ __________________________ _______________________ __________________________ Period(s) of Leave: For the academic year, 20 to 20 , check below the option for which you choose to apply: % First semester, full pay % Second semester, full pay % 10-month academic year, half pay % Divided leave*: Begin __________ End _________; Begin __________ End _________ ________________________________________________________________________________ *For divided leave, please specify all periods (with dates) in 20 , and in the subsequent academic year 20 ; these should add up to either five months at full salary or ten months at half salary. (See special comments under "Terms of Leave" in Document F-II, Sabbatical Leaves of Absence Program at HYPERLINK "https://www.indiana.edu/~vpfaa/academicguide/index.php/Policy_F-2"https://www.indiana.edu/~vpfaa/academicguide/index.php/Policy_F-2) Action by Department Chairperson: Please attach a statement (a) evaluating the proposed project and (b) explaining scheduling adjustments that can be made within the department. The evaluation may be based on advice from a departmental committee, from colleagues, or from external evaluators. Whether or not the chairperson approves the application, it must be forwarded to the dean of the school and the Vice Provost for Faculty and Academic Affairs. [Note: Department chairs who are applying for sabbatical should solicit an independent letter of evaluation from a valued departmental colleague such as an associate chair, director of graduate studies, or other senior member of the faculty.] I (do) (do not) recommend the approval of this sabbatical leave project. (Attach explanatory memo.) _______________________________ __________ (Chairperson) (Date) Signature of Dean: % Scheduling adjustments can be made within the department (or school) without need for additional resources. ________________________________ __________ (Dean) (Date) ELIGIBILITY CERTIFICATION: ________________________________ __________ (Vice Provost, Faculty & Academic Affairs) (Date) SABBATICAL LEAVE 1. Title of proposed sabbatical-leave project. 2. Description of project. Describe your project below. Make clear the purpose of the project and explain its rationale. Provide enough detail on procedures, time schedule, and resources so that the plan can be judged for thoroughness of planning and for feasibility. Explain how you intend to allocate your time to the different tasks you plan to undertake. PLEASE NOTE: If you have submitted a grant application for the same research project you wish to pursue while on sabbatical leave, you may attach a copy, and on this and the following page, provide a concise summary of the plans for the proposed leave and its relation to the grant project. (If necessary, attach extra sheets) -2- 3. Location of Project. State the principal location of your project. Indicate plans for travel and arrangements for use of libraries, laboratories, or work with colleagues at other institutions. If you plan to work at other libraries, archives, institutions, laboratories, or the like, please indicate whether you have yet secured permission to do so. 4. Applicant's Qualifications. Summarize your academic background and accomplishments related to this project and which bear upon its probable success. Attach a current curriculum vitae and other relevant data. 5. Sources and amounts of funds. List sources and amounts of funds in the form of grant, fellowship, allowance for expenses, or payment for services (include approved teaching) during the period of the sabbatical leave. (Please note that the Academic Handbook requires that such funds must be paid for services which are consistent with the sabbatical leave program. Therefore, most regular teaching, consulting, or similar activities may not be used to supplement a sabbatical stipend.) Please indicate to what degree your sabbatical plan will be dependent on the availability of these funds, and how the sabbatical plan will be modified if the funds are unavailable. 6. Dissemination of Information. Explain how you will disseminate the results of your research or creative activity or apply the knowledge gained during your sabbatical leave. 7. Signature of Applicant. I have read the rules governing the sabbatical leave of absence program in the Academic Guide. I agree not to accept any employment during the period of leave that has not been explained in this application. IO% > C D p q             ᗌxpxhxpxhsvCJaJhQCJaJhQ>*CJaJhsvhjCJaJhsvhsvCJaJhzCJaJh=ih3rCJaJh=ihCJaJh=ih CJaJh=ihwFCJaJh=ih1KCJaJh=ihuBCJaJh=ihz>*CJaJh=ihzCJaJhb)ohz('HIE F   S X z . <=@&gdwF@&gdzgdz$a$gdz $@&a$gdb)o " #  $ 2 8 : F d z   , . b d  !$̽⒊yqqhlJLCJaJhQCJaJhQ>*CJaJh<CJaJh=ihEDCJaJhkCJaJh=ih3r>*CJaJh=ihz>*CJaJ h=ihzhzh0Uhz h4mhzhj h4mhh=ihzCJaJhjCJaJhsvhjCJaJ,$'(+-.;<}~F; '>hprs˾˺㘍wsnsnsnsjsjsh#1 hz>*hzh=ihzCJaJh=ihb)oCJaJh=ihHFCJaJh=ih)CJaJh=ihz>*CJaJhkhzCJaJhkhah[0Jhm2jhm2UhkCJaJhlJLCJaJh=ihzCJaJhQCJaJhQ>*CJaJ(=:XZ'9:jkl  ^ `gdz $@&a$gdzP@&^`Pgd"@&gdb)o gdzgdzL_LmFIvx,-.1256RTb4495:5w5|555555555h5hF=0J56CJaJhm2jhm2Uh*i56CJaJhmhz56CJaJhz56CJaJ hz6]Uh"AhN h:#6hh:#6h:#hahz>*h`T hz>*hzhw0     gdzBFH./012  ^ `gd:#  ^ `gdz$a$gdzgdz44595N6R6T6U6W6X6Z6[6]6^6g6h6i6j6k6l6h]hgdu &`#$gdu $@&a$gdd x^gdz gdzh^hgdzgdzIn the event I do not return for at least one year immediately following the sabbatical leave, I agree to reimburse Indiana University for any salary, retirement contributions, and insurance premiums paid during the sabbatical leave. ________________________________ __________ (Signature of Applicant) (Date) *We request that you submit an additional, electronic copy of this application, in the form of a floppy disk, CD, or email attachment to HYPERLINK "mailto:vpfaa@indiana.edu"vpfaa@indiana.edu , in order that your application may be incorporated into our electronic database. -3-     PAGE  55L6N6Q6R6S6U6V6X6Y6[6\6^6_6e6f6g6h6i6j6k6l6m6¸hX(hM4 hM40Jjhm20JUh\jh\U hdhdhzhmhz56CJaJhmhz56CJaJhF=56CJaJl6m6 $@&a$gdd;0P:pv`/ =!"8#$% Dp^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ zNormalCJ_HaJmH sH tH DA`D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List 6U@6 : Hyperlink >*B*phL^@L : Normal (Web)dd[$\$ B*phFVF |FollowedHyperlink >*B* ph4 @"4 :tFooter !.)@1. :t Page Number4B4 ]Header !PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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