Application for Study Leave
Staff Details:
Name:
Staff No:
Division/Faculty/Office/Section:
Employment Status:
Part-time ……………. hrs/ week.
Full-Time
Eligibility: [You must be able to answer yes to each of the following to be eligible for Study Leave.]
I am a general staff member and currently hold continuing or fixed term appointment.
Yes
I have completed my probation period.
Yes
This course is relevant to my current position or a potential future position at CSU.
Yes
NOTE: If you are an indigenous staff member, you may also be eligible for the Indigenous Staff Study Support Scheme.
Course Details:
Are you commencing or continuing a course?
Commencing
Continuing
- Attach offer of admission and subject/module details.
- Attach results from previous session and new session details.
Course Title:
Educational institution:
Course Commencement Date:
Course Completion Date:
Type of Session: [Semester/Trimester etc.]
Are you applying for study leave for the purpose of distance or self-paced study? [Please circle.]
Yes
No
Will you be attending lectures/ tutorials/ practical classes/ residential school? [If yes, please specify below.]
Yes
No
Subject / Module Name
Day of Week
[Monday – Friday]
Start Time
Finish Time
Study Leave Details:
Number of hours applied for:
………….hrs/ week
How many weeks will you require study leave?
………….weeks
When will this session commence?
…..../……/……
When will this session conclude?
……/……/……
Will you require special leave to attend examinations?
Yes
No
[Maximum of 4 hours per week per session for full time staff.]
[if yes, apply for special leave via Web Kiosk when dates are known.]
I agree to make regular progress reports to my Manager and renew this form at the commencement of each new session. Yes
I have attached the relevant information as required in section 6.7 and 6.8 of the Study Leave Policy: Yes
Signature: ………………………………… Date: …….. /……../……..
Approval:
Study Leave supported by [Manager]:
Study Leave approved by [Dean/ Executive Director/ or equivalent]:
Signature: ………………………………… Date: …….. /……../……..
Signature: …………………………………. Date: …….. /……../……..
Please forward this approved form, including attachment,s to: Organisational and People Capability Office
Division of Human Resources,
David Asimus Court, Wagga Wagga Campus
The personal information you provide on this form is protected by the Privacy and Personal Information Protection Act 1998 (NSW). Provision of this information is a requirement of participation in
CSU's Study Leave for General Staff. Access to the information you provide is available to yourself, your supervisor, the Executive Director / Dean / or equivalent, and those persons authorised to
access the information in the course of their duties to CSU. This
Application for Study Leave: 2012