Sabbatical Leave Application for _____________________
Page 1
Name
SABBATICAL LEAVE APPLICATION and REVISION
Fall
(year)
Spring
(year)
Fall and Spring
(academic year)
Completed Application with signatures must be submitted to the Office of Instructional Services by November 1.
Name:
Department(s):
 This form is structured in a two-column format to provide space for information related to your original sabbatical leave
application (left column) and any revisions to the approved sabbatical activities (right column). This structure is
designed to help the Sabbatical Leave Committee evaluate proposals and revisions.
 Space supplied for revisions is to be used only after your sabbatical has been approved. The proposal for revision
must be signed by the chairperson/director and dean, and submitted to the Sabbatical Leave Committee PRIOR TO
IMPLEMENTATION OF THE REVISED PROPOSAL.
SECTION 1: ABSTRACT
Please provide an abstract of your sabbatical leave, with regard to course of study, research/project, and/or creative work,
including the benefit to the district and students and the nature of your final report. Please Note: This abstract is provided as a
public document to the Governing Board for its review and approval. As such, it should be well-written and concise.
Use this column only if your Application has already received Approval
by the Sabbatical Leave Committee.
Original Abstract
Abstract (Proposed Revision)
Revise the abstract as appropriate. State the reason/rationale for
revising proposal.
Form last revised April 2015
Sabbatical Leave Application for _____________________
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Name
SECTION 2: Sabbatical Work
Sabbatical work may include a Course of Study (Section 2A), a Research/Project (Section 2B), and/or Creative Work
(Section 2C) as applicable to your sabbatical leave proposal. Use each section below as necessary to describe the range of
activities you propose. The total amount of time should reflect a full-time commitment of 720 hours.
Section 2A – Course of Study: Include specific classes, programs, and number of units, etc. Note that only accredited
coursework can be listed in this section. Any non-accredited coursework related to technical programs must be listed in
Section 2B (Research/Project). Due to possible course cancellations, list alternatives in addition to the courses you plan to
take. (e.g. you might list 10 courses from which you will actually choose four.) Attach verification from the institution if a
full load of course study is defined as less than 12 semester units. Attach verification of graduate level courses and
provide a url which will assist the Committee with validation. Activities must be reflected in the Abstract and in Section 6
Description of Final Report.
Course of Study
Course of Study (Proposed Revision)Institution(s):
Institution(s):
Dates of Study:
Dates of Study:
Course(s) of Study:
Course(s) of Study:
Form last revised April 2015
Sabbatical Leave Application for _____________________
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Name
Section 2B – Research/Project: Summarize the objectives, activities (including non-accredited coursework) and the
estimated amount of time (hours) devoted to your research or project. The total amount of time should reflect a full-time
commitment of 720 hours combined with other proposed activities (Course of Study or Creative Work) if applicable. Any
research or project should show a level of academic rigor expected of graduate level study. Activities must be clearly
included in the abstract and in Section 6 Description of Final Report.
Research/Project (such as conducting interviews, completing
non-accredited coursework, gaining new knowledge,
designing new course, completing science-related project)
Research/Project (Proposed Revision)
Proposed Topic(s):
Proposed Topic (s):
Objectives:
Objectives:
Methods/Activities and Estimated Hours:
Methods/Activities and Estimated Hours:
Resource (persons, institutions, publications, etc.):
Resource (persons, institutions, publications etc.):
Form last revised April 2015
Sabbatical Leave Application for _____________________
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Name
Section 2C – Creative Work: Summarize the objectives, activities, and the estimated amount of time devoted to Creative
Work. The total amount of time should reflect a full-time commitment of 720 hours combined with other proposed activities
(Course of Study or Research/Project) if applicable. Activities must be clearly included in the abstract and in Section 6
Description of Final Report.
Creative Work
Nature of activity or project:
Creative Work (Proposed Revision)
Nature of activity or project:
Objectives:
Objectives:
Activities and Estimated Hours:
Activities and Estimated Hours:
Resources:
Resources:
Form last revised April 2015
Sabbatical Leave Application for _____________________
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Name
SECTION 3: BENEFITS TO THE DISTRICT AND STUDENTS
Describe the expected benefits to the District and students. This may include items such as development or update of
classroom materials, learning to apply effective teaching strategies to enhance student learning, or activities to maintain
currency in your discipline.
Benefits to the District and Students
Benefits to the District and Students (Proposed Revision)
Indicate any changes to the expected benefits to the District and
students.
SECTION 4: NEW SKILLS OR KNOWLEDGE
Describe new skills or knowledge you expect to gain.
New Skills or Knowledge
New Skills or Knowledge (Proposed Revision)
Indicate any changes to the skills or knowledge you expect to gain.
Form last revised April 2015
Sabbatical Leave Application for _____________________
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Name
Section 5: DISTRICT EQUIPMENT
List any district equipment you plan to use while on sabbatical leave. Authorization from the appropriate supervisor is
required.
Use of District Equipment
Use of District Equipment (Proposed Revision)
Indicate any changes to district equipment you had planned to use.
Supervisor’s Signature
Date
__________________________________________________
Supervisor’s Signature
Date
Section 6: DESCRIPTION OF FINAL REPORT
Describe in detail what you will submit to the Sabbatical Leave Committee to document that the objectives/activities set
forth in this proposal have been achieved. This description must be covered in your Abstract in Section 1.
Description of Final Report
Description of Final Report (Proposed Revision)
Include detail for the entire Sabbatical Leave, not just the revised
portion.
Form last revised April 2015
Sabbatical Leave Application for _____________________
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Name
Section 7: ADDITIONAL COMMENTS OR DOCUMENTATION
Include any additional comments or documentation that might aid reviewers in evaluating your proposal.
Additional Comments or Documentation
Additional Comments or Documentation (Proposed Revision)
I have read and understand the Governing Board Sabbatical
Leave Policy and Procedures, and I agree to abide by the
conditions set forth therein.
REVISION
__________________________________________________
Applicant’s Signature
Date
_________________________________________________________
Applicant’s Signature
Date
Form last revised April 2015
Sabbatical Leave Application for _____________________
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Name
SABBATICAL LEAVE APPLICATION
REVISION
SIGNATURES:
SIGNATURES:
If the applicant holds 40 percent or more contract assignment in a
different department, signatures from both chairpersons/directors
are required throughout the process.
*Comments required for non-endorsement.
*Comments required for non-endorsement.
_____________________________
_______ _______ _______
Chairperson/Director or Department Endorse *Do Not Date
Representative if applicant is
Endorse
Chairperson/Director
_____________________________
Dean
_______
Endorse
_________
*Do Not
Endorse
____
Date
______________________________
Dean
_______ ________
Endorse *Do Not
Endorse
______
Date
+Comments required for disapproval.
_____________________________
**Sabbatical Leave Committee
Comments required for disapproval/not recommend.
_________________________ _________ ___________
Vice President
Approve
Disapprove
_____________________________
_______ ________ ______
Chairperson/Director or Department Endorse *Do Not
Date
Representative if applicant is
Endorse
Chairperson/Director
_______ __________ ______
Approve +Disapprove Date
_______
Date
__________________________ _____________ _______________
**Sabbatical Leave Committee Recommend
Not Recommend
Date_________________________
__________________________ ____________ _______________
**Superintendent/President
Recommend
Not Recommend
Date_________________________
** Office of Instructional Services will obtain signatures.
GOVERNING BOARD ACTION
Date ______________________ Approved ______ Denied _______
**Office of Instructional Services will obtain signatures.
Form last revised April 2015
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Application & Revision