Professional Development Leave For Academic Professional and Administrative



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U Wide Form

UM 1633


Rev: 05/09



Professional Development Leave For

Academic Professional and Administrative


Employees
  1. Complete UM 1633: P&A Development Leave form and submit to responsible administrator.


  2. If request is approved, signed copies are maintained by the:

     Responsible Administrator

     Department




  3. Enter approved leave information into PeopleSoft prior to the beginning of the development leave.


For more information, see the Board of Regents Policy: Employee Development, Education, and Training and the University Administrative Policy/Procedures: Professional Development for Academic Professional and Administrative Employees.

Applicant Information


Name

     

Empl ID

     

Title

     

Job Code

     

DeptID

Entity

College/Administrative Unit

     

Start Date of Requested Leave

     

End Date of Requested Leave

     

Annual Full-Time

Base Salary      



Appointment Term

     

9 to 10 mo. term paid over 12

 Yes


 No

Appointment Type

 K  G  L

 J  H  M

 Z




Type of Development Leave  Mini-Leave  Short-term Leave  Extended Leave

List Applicable Years of Service for Eligibility:


     



Leave Information – attach additional information if necessary


Reason for Requesting Leave:

     


Location of Leave:


     

Outline of Program/Studies or Other Work Proposed:


     



The University of Minnesota is an equal opportunity educator & employer.

 2009 by the Regents of the University of Minnesota.



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List other income to be received during development leave including any grant or scholarship monies:

     




Dates and types of previous development leaves – Attach any corresponding “Report of Leave” documents, if available


Mini Leave:

     



Short-term Leave:

     


Extended Leave:

     



Other:

     




  • I will submit a report on my development leave to the responsible administrator within one month of returning.

  • In the event that I do not return to the University of Minnesota for a period at least equal to the period of the leave, I agree to following terms except in the case where a written waiver is granted:

  1. I will reimburse the University of Minnesota for any salary paid during the development leave, and

  2. I will reimburse the University of Minnesota for its share of the retirement contributions and insurance premiums paid during the development leave.

  • I have disclosed all other salary or compensation for services to be received during this leave.


Requested in accordance with the Board of Regents Policy: Employee Development, Education, and Training and the University Administrative Policy/Procedures: Professional Development for Academic Professional and Administrative Employees.


Applicant Signature


Date      

Campus Address

     

Phone Number      




College/Administrative Unit Screening Committee, if appropriate


Rank or priority given this application



Total number of applications      


Comments

     

Signed

Date

     


Approved

Responsible Administrator Signature

Date

     



The University of Minnesota is an equal opportunity educator & employer.

 2009 by the Regents of the University of Minnesota.



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