Formal Leave Application - DOC - DOC by klz20337

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									                              CENTRAL WASHINGTON UNIVERSITY

                                EXEMPT EMPLOYEES
                        APPLICATION FOR PROFESSIONAL LEAVE


INSTRUCTIONS: Professional leave may be granted in accordance with RCW
28B.10.650 to provide opportunities for exempt employees to study, research, or conduct
creative activities for the enhancement of the university’s instructional and research
programs. Please refer to the Exempt Code, Section 4.16, for full details regarding
Professional Leave. Complete the information requested below. Attach a formal
statement providing the additional information requested in code section 4.163
Application Process, and assurance of compliance to the special conditions outlined in
section 4.164.


Name: __________________________________________________________

Title: ___________________________________________________________

Department:        ____________________________________________________

Date of Exempt Service at CWU: ____________________________________

Proposed Leave Dates: _____________________________________________

Previous Leave Dates: _____________________________________________

My formal statement is attached which includes details of the benefit to the university
(i.e., "enhancement of the university's instructional and research programs") and how the
time requested will be used. The following is a brief summary of the project for which I
am requesting leave:




______________________________________________________________________
Signature of Applicant                                   Date

                                                    Page 1 of 2



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                             ENDORSEMENTS/RECOMMENDATIONS

1) [ ] I support this professional leave application and verify that the applicant can be
released for the requested period of time with his/her duties and responsibilities covered
within existing institutional resources.
 . [ ] I do not support this professional leave application.

______________________________________________________________________
Signature of Supervisor                                     Date



2) [ ] I support this professional leave application and verify that adequate funding is
available and that the purpose of the leave is within the scope of the guidelines
established by RCW 28B.10.650 and is consistent with university priorities and needs.
   [ ] I do not support this professional leave application.

_______________________________________________________________________
Signature of Department Head                                Date



3) I [ ]do [ ]do not support this professional leave application.

________________________________________________________________________
Signature of Appointing Authority/Dean                      Date



4) [ ] I recommend approval. [ ] I do not recommend approval.

________________________________________________________________________
Signature of Vice President                                 Date



5) [ ] I recommend approval. [ ] I do not recommend approval.

________________________________________________________________________
Signature of President                                      Date



                                                    Page 2 of 2

Form: CWU/HR/Exempt Professional Leave Application 08/05



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