WolfSpace Repository (Stony Brook Univ.)

BSU_Page_25

OCR Image Size III Plus

Statesman, V. 32, n. 53.

Statesman, V. 46, n. 25.

Statesman V. 29, n. 54.

CEC Year End Report 2005-2006 Revised

Stony Brook Press V. 18, N. 12.

Statesman, V.21, n. 31.

emery bk17 p26.

STATE UNIVERSITY OF NEW YORK AT STONY BROOK 
 
Sabbatical Leave Request 
 
Name _______________________________________________ Date__________________________ 
 
Rank_______________________________________  Department_____________________________ 
 
Sabbatical Leave Requested for: From_____________________     To_________________________ 
 
 ...........................................................................................................................................................……… 
 
COMPLETE DESCRIPTION OF PROPOSED SABBATICAL PROJECT (attach extra sheets if necessary): 
Describe the scholarly and research objectives to be accomplished, your particular qualifications for the 
proposed project, and the relevance of the project to the University's mission 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Indicate any prospective salary and/or other income during the leave period. Please be specific. If you will 
receive no other income, please indicate none. 
 
 
SUSB 2555-R R-1 [1-04]                                                                                                                                                                             Page 1
PERIOD OF LAST SABBATICAL LEAVE: From___________________ to______________ 
 
Please describe briefly the project and tangible results of that effort. Make specific reference to published 
works or other appropriate materials directly resulting from that endeavor. (Attach additional sheets if 
necessary) 
SUSB 2555-R R-1 [1-04]                                                                                                                                                                             Page 2
Please summarize briefly your contributions to teaching in the period since your last sabbatical leave (or 
past six years, whichever is the shorter period).  For each semester during that period, please list the 
courses that you have taught by course number and name (with cross-listings, if relevant), the approximate 
enrollment, and, if the course was team taught, the fraction of class meetings for which you were primarily 
responsible.  Please note the reason for any approved reductions from the normal teaching assignment for 
your discipline. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
/ understand that in requesting the above listed period of sabbatical leave, / agree to return to the State 
University of New York at Stony Brook for a period of one year from the termination of the leave and if / do 
not return to remit any salary paid by the University during the leave period. / further agree to provide within 
three months of my return a detailed written report on my professional activities during the leave period.  A 
copy of my cv is attached to this request (required).  
 
 
 
Signature________________________________________________  Date_______________________ 
SUSB 2555-R R-1 [1-04]                                                                                                                                                                             Page 3
STATE UNIVERSITY OF NEW YORK AT STONY BROOK 
 
Sabbatical Leave Endorsements 
 
I. Department Chair's Support/Non-Support of Request: 
 
Please provide your assessment of this request. Include a brief statement on the proposed method of 
handling the instructional and academic obligations of the faculty member on leave. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signature:_____________________________________________ Date________________________ 
 
SUSB 2555-R R-1 [1-04]                                                                                                                                                                             Page 4
I. Dean's Support/Non-Support of Request: 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signature:________________________________________________ Date______________________ 
 
 
 
Ill. Vice President for Health Sciences Support/Non-Support of Request (if applicable): 
 
 
 
Signature:________________________________________________ Date______________________ 
 
 
 
IV. Provost's Concurrence/Non-Concurrence: 
 
 
 
 
Signature:________________________________________________ Date______________________ 
 
 
 
V. President's Approval/Disapproval of Sabbatical Request:: 
 
 
 
 
 
Signature:________________________________________________  Date_______________________ 
SUSB 2555-R R-1 [1-04]                                                                                                                                                                             Page 5


English

sabbatical.

Not a member yet