July 1, 2003 AA-1441.1A

AA-1441.1A July 1, 2003

REQUEST FOR RELEASED TIME

Name    

Division            Campus 

I request that the above-named individual be assigned released time during the:

  Fall Semester     Spring Semester       Summer Session    Year:

Describe Purpose of and Justification for Released Time:

Describe Duties to Be Performed:

Amount of Time Requested:  20%    40%  Other:   %

Percentage Teaching Load:  20%    40%  Other:   %

* * * * * * * * * * * * * * * * * To Be Completed by Division Dean* * * * * * * * * * * * * * * * *

Staffing Plan for Released Classes:  (Include number/description of equivalent classes from which faculty member is released. Provide number of adjunct faculty appointments and/or names of faculty member(s) with overload contracts required to offer released classes, if applicable.)

* * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** * * *

Approved:

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