UPPS No. 04.04.35, Application for Staff Educational Development Leave

Attachment I


                       TEXAS STATE UNIVERSITY
                          Application for
                 Staff Educational Development Leave


Name:  ______________________________________  Date:  _______________

Position:  _____________________________ Department:  _______________

    Education:  List institutions of higher learning attended, dates of
    attendance, major field of study, and degree earned, if any.

    _____________________________________________________________________

    Institution     Location    Dates Attended     Major    Degree/Date
    _____________________________________________________________________

    _____________________________________________________________________

    _____________________________________________________________________

    _____________________________________________________________________

    Professional Background and Activities:

    1.  Number of consecutive years of full-time service at Texas
        State University:  ______.

    2.  List your professional activities, publications, awards and
        honors.








    3.  Number of years since last degree or substantial graduate study.
        Include any explanation that you wish.






    Purpose of Leave:  Which of the following describe the purpose of the
    leave requested?

         ____ To improve job effectiveness.

         ____ To complete degree requirements.

         ____ Other.  Describe:  _______________________________________

              __________________________________________________________

              __________________________________________________________


    Description of Courses:  Write a brief description of the course
    offerings for which the leave requested.  Explain why you believe
    that the courses are job related and why you believe that it will
    benefit you and Texas State University.  Attach to this application
    any additional information and papers which you feel will be useful
    in evaluating your request.

















    Period of Leave:

    I request _____ hours of leave for the _______ semester of _____.

    It is my intent to remain at Texas State University at least one
    academic year after the completion of my leave. If I do not
    fulfill my year of service, I agree to reimburse the University the
    amount I receive as salary and tuition and fees from the State of
    Texas while on leave.


                                    ______________________________
                                        Signature of Applicant


To the Director/Account Manager:

    Please answer the following and forward this application to the
    Dean/Director of your division.

     	 1.  Explain the impact the absence of the applicant will have on
	     the affected department, and what accommodations will be made
             to minimize the impact.

	     ____________________________________________________________

    	     ____________________________________________________________

    	     ____________________________________________________________


    	 2.  Do you have serious doubts as to the success of the
             applicant?

             _____ Yes   _____ No

             If yes, explain ____________________________________________

    	     ____________________________________________________________

    	     ____________________________________________________________

         4.  Make any other clarifying marks which you believe to be
             appropriate.

    	     ____________________________________________________________

    	     ____________________________________________________________

    	     ____________________________________________________________

    	     ____________________________________________________________



    	     				     ____________________________
    	                                       Director/Account Manager

                                             ____________________________
                                                  Department


To the Dean/Director:

    Please make any remarks that you desire and forward this application
    to your Vice President.

             ____________________________________________________________

             ____________________________________________________________

             ____________________________________________________________

             ____________________________________________________________

             ____________________________________________________________

             ____________________________________________________________



                                             ____________________________
                                               Dean/Director


                                             ____________________________
                                               Department


NOTE:

    Applications are due in the vice president's office by March 1 for the
    fall semester and October 1 for the spring semester.


    UPPS Form No. 04.04.35/HR/1296