Augsburg College

Application for Leave of Absence

 

Name:                                                                                                                         

 

Department:                                                                                                                

 

Date of Proposed Leave of Absence: Year:                Terms:                       

 

Year you began full-time service to Augsburg College:                                 

 

Years of full-time service to Augsburg College:                                                       

 

Year of last leave of absence with compensation from the college, if any:                                                                                                                                           

 

Highest completed academic degree:                                                             

 

NOTE: If it is your intention to pursue graduate work toward an advanced degree during the proposed leave of absence, please inform the Academic Dean.

 

1, Please explain the project(s) you plan to pursue during your leave of absence:

 

2. In what way(s) do you believe your project(s) will benefit:

            a. Your professional growth:

 

            b. The academic program of your department and/or the        college:

 

3. To what other sources have you applied or intend to apply for funds to support your proposed study?

 

4. Please add any further comments you believe are pertinent and important in support of this application.

 

 

The leave of absence program of Augsburg College stipulates that “Acceptance of a study grant from the college implies agreement on the part of the recipient to return to the faculty of the college for at least one year following termination of the leave of absence. In case the recipient does not return to the faculty of the college during the year immediately following termination of his/her leave of absence, the amount of the study grant becomes a loan to the faculty member, to be repaid to the college on a scale acceptable to the college and at an interest rate equal to the rate paid by the college on its current bank obligation.”

 

Please sign this form indicating your acceptance of the above conditions, and return the form with your application.

 

 

 

                                                                                                                                               

                                                            Signature

 

 

                                                                                                                                               

                                                            Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11/99