<p> Milwaukee Area Technical College</p><p>Request for Sabbatical Leave 2015 - 2016</p><p>All applications must be received with proper signatures to Jonathan Feld, Downtown Campus, Main Bldg. Rm M-270 no later than 4:00 p.m. Friday, October 31, 2014 </p><p>Name: ______Date Hired: ______</p><p>Department: ______</p><p>Division: ______</p><p>In which areas are you certified to teach? ______</p><p>______</p><p>Degrees Earned School Date</p><p>______</p><p>______</p><p>______</p><p>Occupational Research Experience</p><p>Skill Area: ______</p><p>______</p><p>Months of full-time experience: ______</p><p>______</p><p>Related research professional skills: ______</p><p>______</p><p>-1-</p><p>Revised 10.01.12 Sabbatical Request Information:</p><p>For which period of time do you want this leave? Give starting and completion dates:</p><p>FROM ______TO ______Month Year Month Year</p><p>1. What do you propose to do and accomplish during the Sabbatical Leave?</p><p>2. How will this Sabbatical Leave improve your teaching skills in your present assignment?</p><p>3. Will this Sabbatical Leave enable you to be retrained for other teaching assignments? (Please explain) </p><p>4. Specifically, how will this Sabbatical Leave benefit students at MATC?</p><p>5. Specifically, how will this Sabbatical Leave benefit your department and division?</p><p>6. Specifically, what are the long-term benefits to the district as a result of this Sabbatical Leave?</p><p>7. If your goal is to continue your academic studies, please complete the following.</p><p> a.Have you already applied for entry into a specific school?</p><p>YES ______NO ______(Institution Name)</p><p> b. Have you already applied and been accepted into a specific program?</p><p>YES ______NO ______</p><p>Revised 10.01.12 -2-</p><p>1. If yes, identify the program and the degree you desire. Also list the number of credits you must earn to achieve this degree and when you proposed to complete all work for this degree. ______</p><p>______</p><p>2. If no, what are your plans? </p><p>______</p><p>______</p><p>8. If your goal is to acquire more occupational experience, have you already made arrangements to work with a specific firm or firms? </p><p>YES ______NO _____</p><p> a. If yes, name the firm or firms. </p><p>______</p><p>______</p><p> b. If no, at what firm or firms are you contemplating seeking employment? </p><p>______</p><p>______</p><p> c. Describe your proposed job description at the firm or firms? </p><p>______</p><p>______</p><p>9. Have you connected your sabbatical work to college staff and/or departments? How?</p><p>10. Describe how your participation in college activities has prepared you for this sabbatical.</p><p>Revised 10.01.12 -3- LETTER OF AGREEMENT</p><p>I, ______, if granted a Sabbatical Leave agree to:</p><p> a. If enrolled in an academic program, successfully complete 12 credits per semester or the number of credit hours necessary to be a full-time student.</p><p> b. If employed in a work study program, reimburse to the district any earnings exceeding the total annual salary that I would ordinarily receive at MATC.</p><p> c. Provide a status report at the end of the first semester of my Sabbatical Leave.</p><p> d. Upon completion of the sabbatical, provide transcripts and/or a certified resume of accomplishments assuring performance consistent with the answers I have given in this request.</p><p> e. Refund my Sabbatical Leave pay if I do not complete the academic or occupational tasks that I have given in this request.</p><p> f. Return to MATC for at least one (1) year of full-time employment, or refund my Sabbatical Leave pay.</p><p> g. In the event of any changes to this proposal, written documentation must be provided to the Provost’s Office. The Provost’s office may renegotiate the terms of this sabbatical.</p><p>______Employee Signature Date</p><p>RECOMMENDATIONS:</p><p>No ____ Yes ______Supervisor Date</p><p>No ____ Yes ______Academic Dean/Campus VP Date</p><p>COMMITTEE REVIEW</p><p>APPROVALS:</p><p>No ____ Yes ______Provost Date</p><p>No ____ Yes ______</p><p>Revised 10.01.12 President Date</p><p>Copies to: Employee, Supervisor, Academic or Campus Vice President, Provost and President -4-</p><p>Revised 10.01.12</p>