The James McKeen Cattell Sabbatical Award
Institution Certification Form
Please mail one copy of this form by December 1 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 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?
___________________________________
3.
What were the dates of the applicant’s last leave
with pay (sabbatical
or paid fellowship)? ____________________________________________
4.
What is the applicant's salary for the
present academic year? ____________________________________________________
5.
What payment does your institution make
to a faculty member on sabbatical leave?
______________________________________
6.
Does your institution cover completely the
fringe benefits of a faculty member
on sabbatical leave? __________________________
7.
If the answer to the previous question is "No,"
what benefits are
not covered, and what is the dollar value of each? _________________
______________________________________
Signature__________________________
Title______________________________
| Instructions: Mail completed form by December 1 to: Christina L. Williams, Secretary James McKeen Cattell Fund Department of Psychological & Brain Sciences Box 90086 Duke University 9 Flowers Drive Durham, NC 27708-0086 |