Author: UAA

Sabbatical Leave Report Form

Name ___________________________________ Coll/Sch _____________________ Dept ______________________
Rank ____________________________________ Leave Dates ________________ through _____________________
Additional material may be attached in response to the following summary
List the objectives of your sabbatical leave as listed in your proposal and indicate how completely they were met.
Provide a summary of your sabbatical activities and the associated benefits to yourself and UAA.
3. Funding Source(s) UAA sabbatical salary $______________ months _________
Other __________________ $ ______________ months _________
__________________ $ ______________ months _________
__________________ $ ______________ months _________
_______________________________ __________ _________________________________ ___________
Faculty Signature Date Department Chair Signature Date
_______________________________ __________ _________________________________ __________
Director Signature Date Dean Signature Date
________________________________ __________
Provost Signature Date