Checklist for Applications for Fellowship Award 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 indicated. Yes or No 4. Duration and dates of proposed leave completed? Yes or No a) If non-consecutive semesters, justification included? Yes or No 5. CV (Updated/Most Recent) attached? Yes or No 6. Detailed description of proposed scholarly activity and/or Research Plan attached? ` Yes or No 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):_____________________________________________________ Office of Academic Personnel (Dated: 12.Oct.2016)