1. REQUEST FOR RELEASED TIME
    2. Name  
    3. Describe Purpose of and Justification for Released Time:
    4. Describe Duties to Be Performed:
    5. Recommended:     Approved:

November 4, 2003* AA-2420.1C
(*Procedural Update 11/29/17; Title Updates 3/26/12; 9/18/06)
 
 
November 4, 2003* AA-2420.1C
(*Procedural Update 11/29/17; Title Updates 3/26/12; 9/18/06)
 


 
 
 
 



REQUEST FOR RELEASED TIME
 



Name    

                       

Division            Campus/Site 
 
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.)


 
 

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



Recommended:           Approved:
 

___________________________ ______
______________________________ ______
 
Division Dean DateVice Chancellor for Academic Affairs Date 

 

 
Original: Division Dean’s Office; Copies to: VCAA Office, Faculty Member, Human Resources Form 2420/001 (11/17)

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