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