Please provide the information requested below and press the "Prepare my
Leave Application" button, then print out the screen that follows. The printed
form, which includes the information you have entered here, can then be signed
and submitted to SFSU Faculty Affairs.
IMPORTANT NOTE: ONLY THOSE CHARACTERS VISIBLE IN THE TEXT BOXES BELOW
WILL APPEAR ON YOUR FINAL COPY. PRESS "RETURN" AT THE END OF EACH LINE OF
TYPE FOR SUCCESSFUL RESULTS. Submit one original and
4 copies of all materials to your college office by October 1, 2003. Incomplete or late applications
will not be considered. All proposals will be read and evaluated by Peer
Review Committee members who are not necessarily expert in your field of
study. Proposals must be written in clear language and must convey sufficient
information about the projects so the Peer Review Committee can understand
them.
APPLICANT DATA
Please respond to each of the following questions:
1. Applicant Name:
First
Middle Initial
Last
Date
The following information (numbers 2 through 6) is required for a Chancellor's
Office Report:
2. Social Security No.:
3. Status: tenuredprobationary full-time Lecturer
4. Faculty rank:: Associate Professor Assistant Professor Lecturer Librarian
5. Sex: male female
6. Ethnicity: White
Black Hispanic Asian American American Indian
7. Amount of funds requested:
Number of WTU's (released time) requested:
8. Department:
9. Phone Numbers:
School/Department:
Office:
10. Address:
Street
City State
ZIP Code
11. Home Telephone: (include area code)
11a. Your fall and spring semester teaching schedules including
the courses and their credit hours.
11b. Other sources of funding or released time you have been awarded
this academic year (i.e., RPDC grant, assigned time, lottery funds, reimbursed
funding from external sources, etc.).
12.
List previous funding under this or other campus programs. Please include
year, amount of award, and the date of your final report.
13.Describe the objectives of the project in terms of the purpose
of the Faculty Affirmative Action Award
14. Describe the proposed timeline and methodology for accomplishing
the objectives.
15. Budget: specific items need to be listed, not merely stated as
"travel" or "clerical support."
NOTE: PLEASE BE SURE TO ATTACH A CURRENT STANDARD
RESUME AND THE LETTER OF SUPPORT FROM THE SCHOOL/DEPARTMENT OR R&T COMMITTEE
CHAIR.
