Application For Special Leave Of Absence Without Pay Form Page 2
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2Application for Special Leave of Absence Without Pay
Page 2
PROPOSED ARRANGEMENT FOR COVERING PROFESSIONAL DUTIES DURING THE LEAVE:
To be completed by the Executive Officer
________________________________________________________________________________________
________________________________________________________________________________________
RECOMMENDATION OF PROGRAM EXECUTIVE COMMITTEE
________Recommended
________Not recommended
Date ________________________
Signed__________________________________________
(Executive Officer)
RECOMMENDATION OF THE PROVOST AND SENIOR VICE PRESIDENT
________Recommended
_______Not recommended
________With retirement credit*
________Without retirement credit
________With credit for movement within schedule**
________Without credit for movement within schedule
Date _________________________
Signed__________________________________________
(Provost and Senior Vice President)
RECOMMENDATION OF THE ACADEMIC REVIEW COMMITTEE
________Recommended
________Not Recommended
________With retirement credit*
________Without retirement credit
________With credit for movement within schedule**
________Without credit for movement within schedule
Date_________________________
Signed__________________________________________
(Chair, Academic Review Committee)
RECOMMENDATION OF THE PRESIDENT
________Recommended
_______Not Recommended
________With retirement credit*
________Without retirement credit
________With credit for movement within schedule**
________Without credit for movement within schedule
________________
_______________________________
Date
Signed
(President or Designee)
*Retirement credit is available only for members in Tier I and Tier II of TRS and only if the leave is taken for specific
purposes.
**Credit for movement within schedule may be recommended to the President only if the project is of such academic,
scholarly, or public importance that it brings honor and recognition to the college.
APPROVAL OF THE UNIVERSITY OFFICE OF FACULTY AND STAFF RELATIONS
(Only required for a third consecutive year of special leave of absence without pay)
________Approved
________Not Approved
__________________________
_________________________________
Date
Signed
S:\ALL\FORMS\Application for LOA Without Pay 3-11-08.rtf
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