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APPENDIX 26C
CALIFORNIA STATE POLYTECHNIC UNIVERSITY POMONA
OFF-CYCLE DIFFERENCE-IN-PAY LEAVE REQUEST

INSTRUCTIONS

  1. Complete the information below. Page 26C-1 shall serve as the cover sheet to your request.

  2. Prepare an abstract of your leave proposal on Page 26C-2. This summary should serve as a quick reference to the principal features of your leave proposal.

  3. Prepare a statement explaining the nature of the proposed program including the items listed on Page 26C-3.

  4. Attach a résumé or c.v.

SEE THE OFF-CYCLE DIFFERENCE-IN-PAY LEAVE REQUEST PROCEDURE AND ARTICLE 28 OF THE UNIT 3 (FACULTY) COLLECTIVE BARGAINING AGREEMENT.

CANDIDATE INFORMATION

Name ___________________________________________________________________

Academic Rank and Step ____________________________________________________

Department ____________________ College /School/Library _____________________

Date Appointed to Full-Time Position __________________________________________

Number, dates and periods of previous leaves-with-pay granted candidate by this university

___________________________________________________________________

___________________________________________________________________


Period of Leave _____________________________________________________
(give quarters)



ABSTRACT OF LEAVE PROPOSAL

PLEASE LIMIT YOUR RESPONSES TO THE SPACES PROVIDED.


GOALS AND OBJECTIVES

 

 

PLAN OR SCHEDULE FOR ACHIEVING GOALS
(e.g., study plan, highlights of travel and meeting itinerary, writing schedule, course work, etc.)

 

 

ANTICIPATED RESULTS OF LEAVE
(e.g., titles or topics of expected books, journal articles, manuals, art work, lectures, etc.)

 

 


ADDITIONAL COMMENTS
(e.g., special institutional arrangements, invitations, graduate admissions or progress)

 

PROFESSIONAL LEAVE PROPOSAL

Attach a statement explaining the nature of the proposed program, showing how the candidate and university will benefit as a result of the experience to be gained by the candidate during the leave. The statement shall address all items shown below. Attach copies of any documents that would clearly support your proposal.

  1. Purpose of leave.

  2. Extent of travel - dates and itinerary.

  3. Schools, agencies, industries, etc., where study or travel is planned, status of preparation required prior to leave.

  4. Auspices under which study is to be done. Provide available documentation. Attach copies of appropriate letters of invitation, correspondence with cooperators or institutes, graduate student agreements.

  5. Will your leave program produce any benefits for Cal Poly? If so, please explain in detail.

  6. Why are you asking for a leave at this time?

  7. Your academic preparation and professional experience applicable to proposed
    program.

  8. Nature, amount, and sources of anticipated supplementary support (scholarship, fellowship, part-time teaching fellowship, research grants) for this project or proposal.

  9. Indicate any previous work or preparation in direct support of your proposed leave program (include pertinent dates, arrangements or agreements, indications of progress, etc.).

 

 

Appendix 26AD-3
April, 1996