| ____________________________________________
Date of Report |
____________________________________________
Start, End Dates of Sabbatical |
| ____________________________________________
Name (Last, First, Middle Initial) |
____________________________________________
Academic Rank |
| ____________________________________________
School |
___________________________________________
Department |
| ¨ Reviewed and approved by the Department Chair | _______________________________
Date |
| ____________________________________________
Signature |
| ¨ Reviewed and approved by the Dean of the School | ________________________________
Date |
| _____________________________________________
Signature |
| ¨ Reviewed and approved by the Provost | ________________________________
Date |
| _____________________________________________
Signature |
SUGGESTIONS