It is hereby recommended that _________________________, a faculty member in ____________________(department/division /unit), be granted a leave without pay for the period of ____________ through ______________. The leave is to permit the faculty member to engage in the following activity/activities.

(Please list activity in this space)

By Board of Regents' policy, the period during which a faculty member is on leave without pay does not count toward a Sabbatical Leave. This (___ is ___ is not ) considered a scholarly leave (one whose principal outcomes are expected to be scholarly or creative) and, in accordance with Regents' policy, (___will ___will not) count toward tenure.