The James McKeen Cattell Sabbatical Award

Institution Certification Form

Please mail one copy of this form by December 7 to the address below.

Name of Applicant ________________________________________________________

Institution _______________________________________________________________

Academic Rank ___________________________________________________________

Certification Completed by (Name, Title): ______________________________________

1a. Is the applicant a tenured member of
the faculty of your institution?_______________________________________________

b. Will the applicant officially be a tenured member of the faculty by March following this December application?

2. Will the applicant be eligible for a
sabbatical under your standard procedures in AY 2013-2014?___________________________________

3. What were the dates of the applicant’s last leave with pay? (Note that for the purposes of this award we consider a leave/sabbatical as any funded leave that allows a faculty member to spend all of their time on research without administrative or teaching responsibilities. Please report here any leave funded by grant support, university/college supported sabbatical or junior faculty leave, but do not report parental or sick leave, or lightened teaching load if administrative/advising responsibilities were still required). ____________________________________________

4. Will the candidate be on sabbatical in the Spring semester of 2013? _______________

5. What is the applicant's salary for the
present academic year? ____________________________________________________

6. What payment does your institution make
to a faculty member on sabbatical leave? ______________________________________

7. Does your institution cover completely the
fringe benefits of a faculty member on sabbatical leave? __________________________

8. If the answer to the previous question is "No,"
what benefits are not covered, and what is the dollar value of each? _________________




Mail completed form by December 7 to:
Christina L. Williams, Secretary
James McKeen Cattell Fund
Department of Psychological & Neuroscience
Genome Sciences Research Building II 3rd floor
572 Research Drive Box 91050
Duke University
Durham, NC 27708
Phone: 919-660-5638 (for Fed Ex use only, please e-mail if information is needed)
Fax: (919) 660-5798