TRINITY COLLEGE
ACADEMIC LEAVE REQUEST FORM
Name:
Department:
1. What type of leave are you requesting? Choose all that apply:
Qualified Leave1
Quad Leave
Leave of Absence
(one 2-course semester)
(without pay)
Junior Faculty Leave
Grant-funded Leave
Other
(one 2-course semester)
(see Question 5)
(describe in Comments)
Comments (optional):
2. In which semester(s) do you propose to take the leave?
Only Fall 2016
Only Spring 2017
AY2017*
*If you checked AY2017, indicate which option below you expect to apply to your leave2:
_____
I will teach no courses during AY17 because I am combining a Leave of Absence (without pay)
with a Quad Leave or Junior Faculty Leave. I elect to receive 40% pay for the year.
_____
I will teach no courses during AY17 because I am combining a Leave of Absence (without pay)
with a Quad Leave or Junior Faculty Leave. I elect to receive 50% pay for the year and will
teach a 6th course during _____ AY16 or _____ AY18 (select one).
_____
I will teach no courses during AY17 because at least one semester is grant-funded.
_____
I will teach no courses during AY17 because I am taking a full year leave of absence without
pay.
_____
I will teach no courses during AY17 because I am combining two Quad Leaves (one of which
was postponed for three years). I elect to receive 80% pay for the year.
_____
I will teach no courses during AY17 because I am combining two Quad Leaves (one of which
was postponed for three years). I elect to receive 100% pay for the year and will teach a 6th
course during _____ AY16 or _____ AY18 (select one).
1
For renewable-term faculty, senior and principal lecturers, and others as described in Appendix A.8.IV.5 of the
Faculty Manual.
2
A leave of absence without pay may be combined with a quadrennial or junior faculty leave to provide a full
academic year leave of absence. As noted in the Faculty Manual, Appendix B.7, Section IV, in any biennium in
which a Faculty member takes two terms off (quadrennial leave and/or leave of absence), the Faculty member will
teach the equivalent of at least six courses in the remainder of the biennium. If the faculty member chooses to teach
only five courses in the biennium, the faculty member will be paid 40% of his or her annual salary, unless the leave
of absence is fully or partially funded by a non-Trinity grant or fellowship, in which case, he or she will teach the
equivalent of at least five courses in the remainder of the biennium.
3. Briefly describe the principal focus of your scholarly or creative work in the leave period.
Indicate specifically what activities you are planning, such as archival work, field work, lab
research, data analysis, writing, artistic creation, etc. What is your timetable for completion of
the work you will be undertaking, and where do you expect to publish or produce the work?
4. In addition to salary support from the College (as applicable), what other resources do you
have available to support your work during the leave period (e.g., current grants, internal or
external; restricted funds)?
5. What plans, do you have to apply for external grant support? What plans have you discussed
with the Director of Faculty Grants? Please use the following table to list grant applications
you have made or plan to submit for the leave period:
Funding Agency Application Due
Period Requested $ Requested
Response Due
*****
All leave requests must be discussed with the department chair or program director before
application to the Dean of Faculty can be made. The faculty member should complete this
form for the chair’s review. The chair will then add his/her letter of endorsement, outlining
the department’s plans for the faculty member’s absence, and submit the request to the
Dean (c/o Sylvia DeMore) not later than September 10th of the year preceding the
academic year for which leave is requested.
The lecture series sponsored by the Faculty Research Committee will focus in future years on
presenting the work of faculty members who have recently completed a College-sponsored
leave. The FRC will contact you at a later date regarding your presentation.
June 15, 2015