Educational Leave Application-University Of Nevada

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UNIVERSITY OF NEVADA, RENO
CLASSIFIED STAFF EDUCATIONAL LEAVE APPLICATION
DEADLINES: June 15 (for fall semester) November 15 (for spring semester)
Name: ______________________________________
Job Title: _____________________________________
College/School/Division: ___________________________
Department: _____________________________
Date of hire with the University of Nevada, Reno: _________________
Years of full time service at the university (5 years required): __________________
Have you ever received an Educational Leave:
Yes
No
If yes, state dates of leave: __________
Degree Sought: _________________________________
Major: _____________
Minor: _____________
Cumulative GPA: __________ Anticipated units completed at time leave would begin: ___________
Units to be completed during leave period: ____________
Leave Dates: Semester Begin Date: ___________
Semester End Date: ____________
Work schedule during leave period (50% FTE =20 hours/week): List days & times: ___________
Work schedule during semester breaks (employee must work at least 75% during semester breaks, but may be required to
work up to 100% FTE during semester breaks): List days & times. ______________
Applications must be submitted with the following items:
•
Completed Application Form
•
Confirmation of college registration for requested leave period
•
College transcripts from your current institution
•
A brief (2-page maximum) typed statement regarding your career plan and goals. Within your statement discuss how an
Educational Leave will contribute to your professional growth and how your Educational Leave will benefit the university.
Also include any relevant honors or activities
•
Statement from your college advisor indicating that you will be able to complete the degree during the requested leave period
I understand and accept the terms and conditions of the university’s Educational Leave Program.
_____________________________________________
Applicant’s Signature
Date
I understand that even though the employee will work 50% FTE during the leave period, the department budget will be
charged for 75% FTE. If the employee works more hours during break periods, then the budget will be charged for those
additional hours as well.
____________________________________________
______________________________________________
Immediate Supervisor’s Signature
Date
Appointing Authority Signature
Date
Recommend Approval:
Yes
No
Recommend Approval:
Yes
No
____________________________________________
______________________________________________
Educational Leave Committee
Date
Human Resources
Date
Recommend Approval:
Yes
No
Recommend Approval:
Yes
No
____________________________________________
_______________________________________________
Vice President, Administration & Finance
Date
President
Date
Recommend Approval:
Yes
No
Approved:
Yes
No
Upon approval by the President the form will be returned to Human Resources. Human Resources will notify employee
and department of status. If approved, a PAF will be required to adjust the FTE to 75% for the approved time frame.
Revised: 6/24/05

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