PROFESSORIAL FACULTY, LECTURER OR INSTRUCTOR REQUEST FORPRIMARY CAREGIVER WORKLOAD REDUCTION

To document your request for workload reduction, please complete all applicable sections on the first page, sign, date, and forward to your Chair. Details of the policy and eligibility requirements may be found at:

Your information
Your Name / Title/Rank / BU ID #
Unit/Department Phone: Office Phone: Home
Home Address- Please include Street, City, State and Zip Code
By checking the following boxes, you attest that:

You will be the primary caregiver during the period of Workload Reduction, for a new child who has joined your family through birth, adoption, foster care or guardianship placement, or newly established legal custodial care.

The requested period of Workload Reduction will be completed within 16 months of the date of the child’s birth or adoption, or the starting date of foster care, guardianship or legal custody.

You intend to return to full workload, provided you are reappointed or your appointment continues after the period of Workload Reduction.

Primary caregiver: someone who is either responsible for more than 50% of the care of a child, or is the sole caretaker of a child for more than 20 hours per week, Monday through Friday, between the hours of 9am-5pm.

I elect the following option:
Paid Workload Reduction, Full-Modified Status: one semester on CRC, i.e. Sept 1 – Jan. 15 or Jan. 16 – May 31; or 14 consecutive weeks for BUMC faculty who do not teach in a semester schedule / Ending On:
Paid Workload Reduction, Half-Modified Status: two semesters on CRC, or 28 consecutive weeks for BUMC faculty who do not teach in a semester schedule / Ending On:
Note: Where applicable, unpaid leave provided by the Family and Medical Leave Act (FMLA) shall run concurrently with Paid Workload Reduction at full-modified or half-modified status as either intermittent or reduced schedule leave. A determination of FMLA applicability will be made at the time Paid Workload Reduction is requested.
Employee Signature / Date

PROFESSORIAL FACULTY, LECTURER OR INSTRUCTOR REQUEST FORPRIMARY CAREGIVER WORKLOAD REDUCTION

Faculty Member’s Name (Last, First, MI) / School, Department
To be completed by Chair and /or Dean (both campuses):
Preliminary Recommendation to Dean Regarding Courses and Duties Coverage.
It is understood that the school or college should first attempt to accommodate reductions in teaching during Workload Reduction by rearrangement of course offerings and teaching assignments, without added expense to the University. Please describe these arrangements below.
Yr.-Sem. / Course Title / Course Number / Est. Enrollment / Arrangement for Coverage
Other Duties: / Arrangement for Coverage:
If due to unusual circumstances, the arrangement for coverage involves added expense to the University (e.g.: replacement faculty or overload payment to current faculty), please indicate the anticipated cost and provide justification.
Please confirm one-year tenure review deferral for CRC tenure-track faculty member. Note that the maximum span of tenure review deferral for all causes is 2 years. / Yes

Please confirm that this faculty member meets the eligibility requirements for Paid Workload Reduction:

Holds one of the following ranks: unmodified or modified professorial title, Lecturer, or Instructor

At the time of this request, the faculty member has either a) a multi-year appointment and has had a minimum of one year of full-time service to the University; or b) has a one-year appointment and had had a minimum of two years of full-time service to the University

Signatures: / Date:
Chair

Dean

PLEASE FORWARD A SIGNED COPY OF THIS FORM TO THE APPROPRIATE PROVOST’S OFFICE AT YOUR EARLIEST CONVENIENCE

April 2011