APPLICATION FOR STUDY LEAVE
Applications for study leave are to be completed electronically, in accordance with the Study Leave
Policy and Procedures, and submitted to the Head of School no later than 31 March in the year
preceding the proposed Study Leave program.
COVER PAGE
Given Name
Family Name
Title
Faculty/Division
School/Section
Present Position
Academic Level
Date of initial appointment to a fixed-term, tenured
or tenurable position at the University of Tasmania
Additional eligible service recognised by the University
of Tasmania for study leave purposes (if applicable)
Date of return from last Study Leave program
Total number of pages contained in Part A
Total number of pages of attachments to Part A
PART A
Application by Staff Member
1.
Summary of Proposed Program (including objectives)
Insert a summary of approximately 150 words the objectives of the study leave and expected
outcomes. Explain how the study leave program is related to developing, maintaining or improving
the skills and knowledge required for research and teaching responsibilities and the strategic
objectives of the School, Faculty and University of Tasmania.
2.
Research Productivity and Teaching Contributions
Insert details of major research development contributions and current research. Applicants should
also attach chronological lists of grants, research higher degree completions, and publications for
the previous 5 years to Part A of the Application.
Insert details of major teaching development contributions. Applicants should also attach
chronological lists of teaching output, such as SETL summaries, Teaching Merit Awards, Teaching
Development Grants, to Part A of the Application.
3.
Proposed Program (including detailed itinerary and activities)
Include a detailed itinerary and activities to be undertaken during the Study Leave program.
Insert in the summary table, with additional rows as necessary, a summary of activities by each
location and place. This will enable a summary of total weeks leave within and outside of Tasmania
to be determined
Summary of Country or Countries and Place(s) where Study Leave will be spent
(please add as many rows as necessary to describe where leave will be spent)
Main Activity
Country
Place
Location
Proposed
Dates
Number of
weeks/days
eg Archival Research
eg Australia
eg Melbourne
eg Melbourne
Archives
eg 1.5.03 –
30.6.03
eg 8wks 5 days
4.
Objectives and Measurable Outcomes
4.1
Please tick the primary objective of the proposed study leave program:
Teaching
4.2
Research
Combination of Teaching ____% and Research ____%
Objectives envisaged for proposed Study Leave, referring in particular to the relationship between
study leave plans and research work and/or teaching responsibilities, present or future.
Objectives
eg:
doctoral
research
completion of PhD
Measurable Outcomes
towards
eg: completion of data collection, transcription and analysis and documentation of
literature.
5.
Detail any other leave being sought in conjunction with Study Leave program (eg annual
leave, long service leave, leave without pay etc). Please note that applicants are required to
take at least the amount of annual leave that accrues during the Study Leave period.
Type of Leave
From
To
Number of
Weeks/Days
From
To
Weeks/Days
Study Leave (within Tasmania)
Study Leave (outside Tasmania)
Annual Leave
Long Service Leave
Leave Without Pay
Other
TOTAL
6.
Estimated expenditure for the Proposed Study Leave program
Air Fare
Cost
Living
Expenses
Other
Total
Comment
Self
Accompanying family
member(s) (specify
relationship and period that
family member(s) will
accompany you outside of
Tasmania)
Other (please specify)
$
Total Estimated Expenses
7.
Details of additional income and/or financial assistance from University and/or external
sources
Amount
Source
Purpose or Nature
of Income or Assistance
8.
Amount of financial assistance requested from the University
$
9.
Current and/or anticipated teaching/research supervision responsibilities during absence if
leave is approved
Teaching
Unit Name
Unit Code
Contact Hours by
lecture, tutorial,
practical, other
Explanatory Comment
Research Supervision
Student Name
Degree
Supervision Arrangements
10.
Agreement
On approval of this application for study leave, I agree to:

submit any variations to the approved study leave application to the Head of School (after
consultation with my direct supervisor, if my direct supervisor is not the Head of School) who will
make a recommendation to the Dean for approval.

submit a Notification to Commence Study Leave and Study Leave Allowance Form to the Dean at
least eight (8) weeks in advance of departure and report any additional income and/or financial
assistance from University and/or external sources granted (or likely to be granted) by that date.

submit the Study Leave Report to the Secretary, Faculty Study Leave Committee within 60
calendar days of returning from study leave. (The University reserves the right to vary the basis of
payment in the event of there being any variation to the information now furnished and that if any
overpayment results from the University exercising such right, it is recoverable by the University).

return from leave to normal duties within the University of Tasmania for a period at least equivalent
to the period of Study Leave, or in default to repay the salary, other allowances and Study Leave
Allowance received during that period or the proportion commensurate with a partial default. In
addition, if in default, to submit at least a partial Study Leave Report comprising Part A Financial
Accountability and Part B Summary for Public Information Purposes is required.

abide by conditions contained in the Study Leave Policy and Procedures.
Date: …………………………
Signature of Applicant: …………………………………………
Attached Additional Documents (please tick)
Research Productivity List
Teaching Output/Contribution List
Previous Study Leave Report
Copy of last Performance Management Planning and Review Form
PART B
Recommendation of Head of School
1.
Please comment on the application using each of the following criteria taking into account the
applicant’s proposed balance of research and teaching objectives.
(i)
Successful completion of previous Study Leave program(s), where applicable:
(ii)
Proven record of productivity or considerable demonstrated potential in the following two areas,
although an application for Study Leave in one area is acceptable:
(a) scholarship and research, as evidenced by the quality and number of publications and/or,
where applicable, other creative achievement:
(b) teaching and teaching development contribution:
(iii)
The academic appropriateness of the proposed Study Leave program which will enhance the
performance of the academic beyond normal academic activities and with specific comment on
proposed methodology, justification and measurable outcomes:
(iv)
Consistency with School and Faculty strategic plans:
(v)
Support of Head of School and assurance of School functioning during absence:
2.
If Study Leave is not recommended due to financial constraints in the School or the inability of
providing teaching relief, indicate how these conditions could be overcome within the subsequent
two years:
3.
Study Leave is:
Rank of application:
Date: …………………………
Recommended
Not Recommended
____ of ____ applications within the School.
Signature: ………………………………………………………
Head of School
PART C
Recommendation by Faculty Study Leave Committee
1. Evaluation of application for Study Leave against criteria listed in the Study Leave Policy (clause 3):
Please  as appropriate:
Unsatisfactory
Less than
Satisfactory
Satisfactory
Very Good
Outstanding
CRITERIA
Successful completion of previous
Study Leave program(s), where
appropriate.
*Proven record of productivity or
considerable demonstrated potential in
scholarship
and
research
as
evidenced by the quality and number
of
publications
and/or,
where
applicable,
other
creative
achievement.
*Proven record of productivity or
considerable demonstrated potential in
teaching and teaching development.
The academic appropriateness of the
study leave program which will
enhance the performance of the
academic beyond normal academic
activities
and
with
measurable
outcomes.
Consistency with School and Faculty
strategic plans.
Support of the Head of School.
*An application for Study Leave in one area is acceptable.
2.
Study Leave is:
Recommended
Not Recommended – financial/teaching relief
Not Recommended – on basis of application
3.
If Study Leave is not recommended due to financial constraints in the School or the inability of
providing teaching relief, the Faculty Study Leave Committee should evaluate the application and
recommended action t be to be taken by the Dean:
Date: ………………………… ……
Signature: ………………………………………………………
Chair, Faculty Study Leave Committee
PART D
Decision by Dean
1.
This application for Study Leave is:
2.
The amount of Study Leave Allowance is: $ _____________
3.
Comments and/or amendments to the proposed Study Leave program (comments are
required if application is not approved):
Date: ………………………… ……
Approved
Not Approved
Signature: ………………………………………………………
Dean
Note:
Following the decision being recorded on the Application for Study Leave, the Dean shall arrange for:
1. Advice to the applicant and Head of School of the decision. All applicants shall be provided with a copy of
Parts B – D of the Application for Study Leave and successful applicants shall be provided with a letter of
invitation to undertake Study Leave; and
2. The original of the Applications for Study Leave (Parts A - C) and related documentation for all applicants
(whether successful or not) to be forwarded to the Secretary, Staff Development Committee no later than
30 June.