MONTOUR SCHOOL DISTRICT

SABBATICAL LEAVE REQUEST

DATE:

SUBJECT: Sabbatical Leave

TO: Montour School Board of Directors

FROM: ______

  1. It is requested that I be granted a sabbatical leave of absence as authorized by the provisions of Sections 1166 through 1171 of the Public School Code (PSC) of 1949, as amended by Act 66 of 1996.
  1. I certify that I have completed ten years, or seven years since my last sabbatical leave, of satisfactory service in the schools of the Commonwealth of Pennsylvania, and that five years of consecutive service has been achieved in the MontourSchool District.

3.The sabbatical leave of absence is requested for one of the following reasons: (Check the appropriate blank)

____Restoration of health

____Professional Development Leave

Employee participating in an academic program for the purpose of retaining a professional certificate or commission, further preparation and improvement in her/her area(s) of certification, additional certification, attaining other appropriate and identifiable educational positions within the school district, or as the Board may require, and upon the recommendation of the Superintendent.

____Other purposes ( Please specify)______

______

  1. The sabbatical leave of absence is requested for one of the following periods:

____A half school term, beginning______

and ending______.

____A full school term, beginning______

and ending______.

____Two half school terms during a period of two years, beginning

______and ending ______, and beginning

______and ending ______.

(Check appropriate time and enter dates)

REGULATIONS

I am aware that Section 1171 of the PSC of 1949 states, “The Board of School Directors shall have the right to make such regulations as they deem necessary to make sure the employees on leave shall utilize such leave properly for the purpose which it was granted, requiring reports from the employee on leave in such manner as they may deem necessary.”

TheMontour School Board of Directors, in order to assure that the leave is used to benefit both the employee and the Montour School District, has made the following regulations with which I shall comply as applicable:

A.If the leave is for Professional development,applicant shall submit notification of acceptance and a detailed plan describing the professional development activitiesto be undertaken which the Superintendent has approved, and a statement specifying the benefits of the leave to the employee and the school district. Applicant will offer proof of the courses which are the equivalent of the following:

1) Nine (9) or more graduate hours of credit per semester or Eighteen (18) annually,

2) Twelve (12) undergraduate credits or Twenty-four (24) annually,

3) One hundred eighty (180) hours of professional development activities or Three hundred sixty (360) annually.

B. If the leave is granted for the restoration of health, I shall submit a certificate from a physician stating that the leave is advisable. At both the midpoint of the leave and at least thirty (30) days prior to the conclusion of the leave, a physician’s statement shall be submitted to the Human Resource Office, indicating the extent to which the purpose of the leave has been achieved and evaluating the health status of the employee relative to his/her ability to return to employment. The Board reserves the right to require at its own expense additional examinations and reports by physicians of its choice to determine the validity of the leave request.

C.If the leave is granted for other purposes, I understand that this is subject to the discretion of the Board of School Directors.

I am aware that Section 1168 of the PSC of 1949, as amended by Act 66 of 1996, requires that I return to the Montour School District for at least one (1) full school year following the leave, unless physically or mentally unable to do so.

I certify that I am aware of the above requirements and intend to comply with them.

______

Employee Signature

**Attached Board Policy #438 for more information on Sabbatical Leave.