Application for Extended Leave Name of Applicant: _____________________________________________________ Title: ________________________________________________________________ Department/Division: ___________________________________________________ Rank: (Lecturers and Support Staff Agreement, 2003-2005, Article 37) _____________________________________________________________________ Period of Extended Leave Requested: __________________ to _________________ Extended Leave: On a separate sheet, please complete your extended leave plan according to the following outline: A. Nature of the educational or professional program to be undertaken including: 1. Leave objectives: Knowledge, experience and/or expertise to be gained from the extended leave for the benefit of the students, colleagues and Bermuda College. 2. Relationship of objectives to college goals, to anticipated duties, or to any approved projects with which you are or anticipate being involved. 3. Extended leave activities planned to accomplish the state objectives. This would include any programmes of study, community services. Colleges/businesses to be visited, travel, materials development, and an approximate time line for the different activities. Indicate any College- provided materials or facilities support you would require: indicate if planning to attend Bermuda College for tuition waiver purposes. B. A summary, in outline form, of what you feel is your outstanding contributions to Bermuda College. C. What expenses for this activity do you wish the Professional Development Committee to consider? Item Vendor/Institution Amount Total (If applicable) Application for Extended Leave Page 2 of 2 Indicate any financial remuneration from other sources to be received during the extended leave, including grants, fellowships, and outside employment. If no outside funding will be received, indicate NONE. Your completion of this section will enable us to assure fair, equitable decisions. Item Vendor Amount Total Statement of Understanding and Compliance (To be completed by employee once extended leave has been approved.) I, _________________________________, understand that extended leave is granted in accordance with Bermuda College policy as outlined in the Lecturers and Support Staff Agreement between Bermuda College and the BPSU. I also understand that I am required to return to Bermuda College for at a period of service equal to the period of extended leave. I agree that if I choose not to return, I shall reimburse Bermuda College all compensation received from the College equivalent to the timeframe of the extended leave period. Should I decide to leave Bermuda College prior to my or within my service payback, I understand that I will be required to reimburse compensation received on a pro-rated basis. This reimbursement will be calculated minus the service already paid back. I understand that funding of this extended leave is guaranteed for one year only. Applicant will be required to submit supporting documentation of successful progress toward completion of extended leave objectives. Applicant __________________________Date _____________________________ Supervisor _________________________ Date _____________________________ Human Resource Director ______________________ Date ____________________ Extended Leave Certification of Eligibility (For Committee Use Only) Applicant is a Permanent Employee: yes______ no_____________ Date of Hire: ______________________________________ Date of Previous Extended Leaves: _________________ to __________________ I certify that the employee above is eligible to apply for the extended leave requested. Signature ________________________________ Date: _________ Human Resources Director ________________________ ____________________________ __________ Recommendation1 P.D. Committee Chair Date ________________________ ____________________________ __________ Recommendation1 VP of Academic Affairs Date ________________________ ____________________________ __________ Recommendation1 CFOO Date 1 If disapproval is recommended, please attach a separate sheet of explanation. Frequently Asked Questions Who is eligible for extended leave? All full-time, non-contract employees are eligible for extended leave. How long should an employee be employed by Bermuda College before he/she is eligible for extended leave? The employee must have been employed by Bermuda College for 3 years. What exactly is extended leave? Extended leave can be defined by the question, “Does someone have to be hired to cover your customary responsibilities at the college?” If your absence will require a tangible adjustment, requiring rescheduling and other modification of duties and responsibilities within your department/division, the leave you are requesting would be considered extended leave. What compensation will I receive while on extended leave? The committee may recommend that an employee receive 75% of their normal compensation for the period of the leave, including benefits. Time spent on extended leave will be counted as service with Bermuda College. The faculty member’s base salary while on extended leave shall be adjusted by applicable salary clauses in the collective agreement. How many extended leaves will the College grant? A maximum of two such extended leaves can be granted each calendar year. Special Procedures To verify eligibility requirements and assist in administrative planning, the Director of Human Resources will be present /sit on the committee as the applications for extended leave are considered. The HR director will also serve as an Ad Hoc committee member when consideration is being given to the application of a serving member of the committee. How far in advance should an application be submitted? To facilitate administrative planning, we recommend 12 months in advance. Please submit six copies of your application and related documents. How soon will I be notified whether my extended leave has been granted? You will be notified within 4 months of your submission. What if the professional development activity I’ve chosen extends beyond one academic year? Approval and funding of your extended leave is guaranteed for one year only.