Please provide accurate and complete information about your current position, departmental affiliation, and professional background. All fields marked as mandatory must be completed for application processing.
Full Legal Name
Faculty ID Number
Current Academic Rank
Assistant Professor
Associate Professor
Full Professor
Research Professor
Distinguished Professor
Other Academic Rank
Primary Department or Academic Unit
Secondary Affiliation (if applicable)
Original Hire Date at Institution
Do you currently hold tenured status?
Date tenure was awarded
Please explain your tenure-track progress and expected timeline
Total Years of Service at Current Institution
Have you previously taken a sabbatical or extended research leave from this institution?
Previous Sabbatical/Extended Leave Details
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Current Academic Year Teaching Assignments
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Current Committee Assignments and Service Responsibilities
Current Student Supervision Responsibilities
Primary Campus Address and Office Location
Institutional Email Address
Primary Contact Phone Number
Emergency Contact Information
Recent Professional Development and Awards (Last 3 Years)
Provide a comprehensive description of your proposed research or academic activities during the leave period. This section is critical for evaluation of your application's merit and institutional benefit.
Type of Leave Requested
Research Sabbatical (Full Salary)
Research Sabbatical (Partial Salary)
Extended Research Leave (Unpaid)
Professional Development Leave
Medical Leave with Research Component
Other Extended Leave
Proposed Start Date of Leave
Proposed End Date of Leave
Total Duration in Months
Research Project Title
Research Project Abstract (500 words maximum)
Detailed Research Objectives and Methodology
Research Timeline and Major Milestones
Target Date | Milestone Description | Deliverable | Success Metrics | ||
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Expected Academic Outcomes (Select all that apply)
Peer-reviewed journal articles
Monograph or book publication
Conference presentations
Grant applications
New course development
Curriculum redesign
Exhibition or performance
Patent application
Public policy report
Other significant outcome
Expected number of journal articles
Anticipated publisher or publication venue
Target funding agencies and anticipated amounts
Primary Host Institution or Research Location
Will this leave involve international travel or residence abroad?
List all international destinations, duration of stay in each location, and any required visas or permits
Does your research involve human subjects?
Describe IRB approval status, ethical considerations, and informed consent procedures
Does your research involve animal subjects?
Describe IACUC approval status and animal welfare protocols
Collaboration and Partnership Plans
Anticipated Benefits to Your Home Institution and Department
Upload Supporting Documents (CV, letters of invitation from host institutions, preliminary data, etc.)
Detail your plan for covering all teaching, supervision, and service responsibilities during your absence. Incomplete plans may result in application delay or denial.
Teaching Responsibilities During Leave Period
Course Code | Course Title | Semester/Term | Credit Hours | Expected Enrollment | Coverage Plan | ||
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Will you require replacement instructors for any courses?
Identify proposed replacement instructors, their qualifications, and confirmation status
Will you continue to teach any courses online or through remote instruction while on leave?
Specify courses, delivery format, and time commitment
Do you require Teaching Assistant (TA) support during your leave?
Describe TA responsibilities, funding source, and supervision plan
Graduate Student Supervision Plan
Student Name | Degree Program | Stage of Progress | Expected Completion Date | Co-Supervisor Arrangement | Communication Plan During Leave | ||
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Undergraduate Student Mentorship and Supervision Plan
Committee Service Responsibilities During Leave
Departmental committees
College/School committees
University-wide committees
Professional association committees
Thesis/dissertation committees
Search committees
No committee responsibilities
Describe coverage plan for departmental committee service
Describe plan for continuing thesis/dissertation committee participation
Administrative Duties During Leave
Departmental administration
Program coordination
Center/Institute directorship
Journal editorship
Conference organization
No administrative duties
Describe interim administrative appointment and handover process
Impact on Current Advisees and Plan for Continued Mentorship
Summary of Alternative Arrangements and Contingency Plans
Full disclosure of all funding sources and financial arrangements during your leave is required for compliance and approval. Incomplete disclosure may result in revocation of leave approval.
Salary Arrangement During Leave
Full salary continuation
Partial salary (percentage specified)
External grant salary coverage
Host institution salary
Unpaid leave
Other arrangement
External Funding Sources Supporting Leave Activities
Funding Agency/Organization | Grant/Program Name | Total Award Amount | Salary Coverage | Research Support | Grant Period Start | Grant Period End | ||
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Will you continue to administer external grants from your home institution during leave?
Describe grant administration plan, including financial management, reporting, and personnel supervision
Do you have any potential or actual conflicts of interest related to your leave activities?
Detail the nature of conflict, parties involved, and mitigation plan
Total Research Budget Requested from Institution
Travel Budget Requested
Equipment and Materials Budget
Total Institutional Support Requested
Budget Justification
Will this research generate intellectual property (patents, copyrights, etc.)?
Describe IP management plan and institutional ownership considerations
Special Requirements from Funding Agencies
Upload Grant Award Letters, Budget Documents, or Funding Agreements
This section must be completed by your Department Chair and Dean. The applicant should not complete this section. All approvals are contingent upon satisfactory completion of all preceding sections.
Department Chair: Assessment of Impact on Departmental Operations
Department Chair: Evaluation of Research Proposal Merit
Department Chair Recommendation
Strongly Recommend Approval
Recommend Approval with Conditions
Recommend Denial
Defer Decision Pending Revisions
Department Chair: Conditions or Concerns
Department Chair: Have you identified an alternative candidate for this leave period if needed?
Name of alternative candidate
Dean: College/School Level Impact Assessment
Dean Recommendation
Strongly Recommend Approval
Recommend Approval with Conditions
Recommend Denial
Refer to Provost for Decision
Dean: Strategic Alignment and Institutional Priority Assessment
Final Decision Deadline
Department Chair Signature
Department Chair Signature Date
Dean Signature
Dean Signature Date
Additional Comments from Department Chair or Dean
Upload Supporting Documentation (letters of support, additional approvals, etc.)
To configure an element, select it on the form.