Application for Study Leave
(for academic staff)
Applications for study leave are to be completed electronically and submitted to the Head of School/Institute no later than 31 March in the year preceding the proposed Study Leave program.
HEADING
.
Family NameGiven Name
Title
College/Division
School/Institute/Section
Position
Academic Level
Date of initial appointment to a fixed-term, tenured
or tenurable position at the University of Tasmania
Additional eligible service recognised by the University
of Tasmania for study leave purposes (if applicable)
Date of return from last Study Leave program
Total number of pages contained in Part A
Total number of pages of attachments to Part A
1.Summa
Insert a summary of approximately 150 words the objectives of the study leave and expected outcomes. Explain how the study leave program is related to developing, maintaining or improving the skills and knowledge required for research and teaching responsibilities and the strategic objectives of the School/Institute, College and University of Tasmania.
2.Research Productivity and Teaching Contributions
Insert details of major research development contributions and current research. Applicants should also attach chronological lists of grants, research higher degree completions, and publications for the previous 5 years to Part A of the Application.
Insert details of major teaching development contributions. Applicants should also attach chronological lists of teaching output, such as student survey summaries, Teaching Merit Awards, Teaching Development Grants, to Part A of the Application.
3.Proposed Program (including detailed itinerary and activities)
Include a detailed itinerary and activities to be undertaken during the Study Leave program.
Insert in the summary table, with additional rows as necessary, a summary of activities by each location and place. This will enable a summary of total weeks leave within and outside of Tasmania to be determined
Summary of Country or Countries and Place(s) where Study Leave will be spent
(please add as many rows as necessary to describe where leave will be spent)
Main Activityeg Archival Research
/ Countryeg Australia
/ Placeeg Melbourne / Location
eg Melbourne Archives / Proposed Dates
eg 1.5.03 – 30.6.03 / Number of weeks/days
eg 8wks 5 days
4.Objectives and Measurable Outcomes
4.1Please tick the primary objective of the proposed study leave program:
TeachingResearchCombination of Teaching ____% and Research ____%
4.2Objectives envisaged for proposed Study Leave, referring in particular to the relationship between study leave plans and research work and/or teaching responsibilities, present or future.
Objectives / Measurable Outcomeseg: doctoral research towards completion of PhD / eg: completion of data collection, transcription and analysis and documentation of literature.
5.Detail any other leave being sought in conjunction with Study Leave program (eg annual leave, long service leave, leave without pay etc). Please note that applicants are required to take at least the amount of annual leave that accrues during the Study Leave period.
Type of Leave / From / To / Number of Weeks/DaysStudy Leave (within Tasmania)
Study Leave (outside Tasmania)
Annual Leave
Long Service Leave
Leave Without Pay
Other
TOTAL / From / To /
Weeks/Days
6.Estimated expenditure for the proposed Study Leave program
Air FareCost / Living
Expenses / Other / Total / Comment
Self
Accompanying family member(s) (specify relationship and period that family member(s) will accompany you outside of Tasmania)
Other (please specify)
Total Estimated Expenses / $
7.Details of additional income and/or financial assistance from University and/or external sources
Amount / Source / Purpose or Natureof Income or Assistance
8.Amount of financial assistance requested from the University
$9.Current and/or anticipated teaching/research supervision responsibilities during absence if leave is approved
Teaching
Unit Name / Unit Code / Contact Hours by lecture, tutorial, practical, other / Explanatory CommentResearch Supervision
Student Name / Degree / Supervision Arrangements10.Agreement
On approval of this application for study leave, I agree to:
- submit any variations to the approved study leave application to the Head of School/Institute (after consultation with my direct supervisor, if my direct supervisor is not the Head of School/Institute) who will make a recommendation to the Executive Dean for approval.
- submit a Notification to Commence Study Leave and Study Leave Allowance Form to the Executive Dean at least eight (8) weeks in advance of departure and report any additional income and/or financial assistance from University and/or external sources granted (or likely to be granted) by that date.
- submit the Study Leave Report to the College Study Leave Committee within 60 calendar days of returning from study leave. (The University reserves the right to vary the basis of payment in the event of there being any variation to the information now furnished and that if any overpayment results from the University exercising such right, it is recoverable by the University).
- return from leave to normal duties within the University of Tasmania for a period at least equivalent to the period of Study Leave, or in default to repay the salary, other allowances and Study Leave Allowance received during that period or the proportion commensurate with a partial default. In addition, if in default, to submit at least a partial Study Leave Report comprising Part A Financial Accountability and Part B Summary for Public Information Purposes is required.
Signature / Date
Signature of Applicant
Attached Additional Documents (please tick)
Research Productivity List
Teaching Output/Contribution List
Previous Study Leave Report
Copy of last Performance Management Planning and Review Form
Issue Date: 25/1/2018Version 1.1 / Academic Study Leave Application / Page 1 of 11
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1.Please comment on the application using each of the following criteria taking into account the applicant’s proposed balance of research and teaching objectives.
(i)Successful completion of previous Study Leave program(s), where applicable:
(ii)Proven record of productivity or considerable demonstrated potential in the following two areas, although an application for Study Leave in one area is acceptable:
(a)scholarship and research, as evidenced by the quality and number of publications and/or, where applicable, other creative achievement:
(b)teaching and teaching development contribution:
(iii)The academic appropriateness of the proposed Study Leave program which will enhance the performance of the academic beyond normal academic activities and with specific comment on proposed methodology, justification and measurable outcomes:
(iv)Consistency with School/Institute and College strategic plans:
(v)Support of Head of School/Institute and assurance of School/Institute functioning during absence:
2.If Study Leave is not recommended due to financial constraints in the School/Institute or the inability of providing teaching relief, indicate how these conditions could be overcome within the subsequent two years:
3.Study Leave is: RecommendedNot Recommended
Rank of application:____ of ____ applications within the School/Institute.
Signature / DateHead of School/Institute
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1.Evaluation of application for Study Leave against criteria:
Please as appropriate:
Unsatisfactory / Less thanSatisfactory / Satisfactory / Very Good / Outstanding / CRITERIA
Successful completion of previous Study Leave program(s), where appropriate.
*Proven record of productivity or considerable demonstrated potential in scholarship and research as evidenced by the quality and number of publications and/or, where applicable, other creative achievement.
*Proven record of productivity or considerable demonstrated potential in teaching and teaching development.
The academic appropriateness of the study leave program which will enhance the performance of the academic beyond normal academic activities and with measurable outcomes.
Consistency with School/Institute and College strategic plans.
Support of the Head of School/Institute
*An application for Study Leave in one area is acceptable.
2.Study Leave is: RecommendedNot Recommended – financial/teaching relief
Not Recommended – on basis of application
3.If Study Leave is not recommended due to financial constraints in the School/Institute or the inability of providing teaching relief, the College Study Leave Committee should evaluate the application and recommended action t be to be taken by the Executive Dean:
Signature / DateChair, College Study Leave Committee
Issue Date: 25/1/2018
Version 1.1 / Academic Study Leave Application / Page 1 of 11
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1.This application for Study Leave is:ApprovedNot Approved
2.The amount of Study Leave Allowance is: $ ______
3.Comments and/or amendments to the proposed Study Leave program (comments are required if application is not approved):
Signature / DateDean
Note:
Following the decision being recorded on the Application for Study Leave, the Dean shall arrange for:
- Advice to the applicant and Head of School/Institute of the decision. All applicants shall be provided with a copy of Parts B – D of the Application for Study Leave and successful applicants shall be provided with a letter of invitation to undertake Study Leave; and
- The original of the Applications for Study Leave (Parts A - C) and related documentation for all applicants (whether successful or not) to be forwarded to the College Study Leave Committee no later than 30 June.
Issue Date: 25/1/2018
Version 1.1 / Academic Study Leave Application / Page 1 of 11