Checklist for Applications for 

Fellowship Award 



Note: 

•Applications accepted only once per academic year in fall (Deadline * Dec. 3)
•Code of Practice Regarding Instructional Staff Academic Leaves – Please read forcomplete details on eligibility, types, review and approval, reporting, calendar leavedates, terminating leave and compensation.
•Submit form to: provost.eforms@lehman.cuny.edu with a copy toEdna.Norman@lehman.cuny.edu andDeborah.RhemJackson@lehman.cuny.edu






Faculty Name: ____________________________________________________________________________ 



School __________________________________Department _____________________________________ 



1. Confirmation of Eligibility from HR (Z. Rosa) attached. Yes or No 



2. Previous Fellowship or Scholar Incentive Leave? Yes or No 



 a) If Yes, copy of last Leave Report attached? Yes or No 





3.Pay Rate, duration and dates of proposed leave completed? Yesor No 



Fellowship Award Information 

Duration and dates of the proposed leave: 



 Full year at 80% of biweekly salary rate Semester __________ Semester __________



 Half year at 80% of biweekly salary rate. Semester__________ 



 Half year at full pay Semester__________ 





a)For a full year request, if non-consecutive semesters,Yes or No 

justification included?





5.Lehman CV (Updated/Most Recent) attached?Yes or No 



6.Detailed description of proposed scholarly activity

and/or Research Plan attached? `Yes or No 








 

Checklist for Applications for 

Fellowship Award - continued 

 

7. Is leave at another Institution? Yes or No 

 

 a) If Yes, Letter of Support attached? Yes or No 

 

 

8. Application Signatures & Approvals: 

 

 a) Faculty Member’s Signature Yes or No 

 b) Chair’s Signature Yes or No 

 c) P&B approval documented. Yes or No 

 d) Dean’s Signature Yes or No 

 

 

Office of Academic Personnel 

 

Date Received: _____________________________________________________________________________ 

 

Reviewed by: _______________________________________________________________________________ 

 

Application Complete? Yes or No 

 

If no, follow-up and result (describe): _____________________________________________________ 

 

_________________________________________________________________________________________________ 

 

 

 

Confirmation of Completed Application – 

 

 Emailed to Applicant (Date): _______________________________________________________