Fellowship Leave / Scholar Incentive Report (NOTE: Text can be expanded or attach additional pages as needed) Name: _________________________ Academic Rank: ________________ Program/Department/School: _________________________ Fellowship Leave / Scholar Incentive Dates: ______________ Date of this Report: _____________ Provide a summary of your original plans and goals. Describe your activities, outcomes and achievements, and links or references to publications or other works during or resulting from the Fellowship Leave / Scholar Incentive. Page 2of 3 Describe and explain changes to your original plan. Assess the value or significance of these changes, if any. Describe how your Fellowship Leave / Scholar Incentive contributed to your personal/professional development and how it provides a benefit to the Department/School/College in terms of (a) Teaching and/or Curriculum Development, (b) Research/Scholarship/Creative Activity, and (c) Service to your Discipline, Lehman College and/or the public. Provide a list of agencies and institutions from which you received financial support to pursue your Scholar Incentive. Faculty Signature: _______________________________ Date: _________________ Review by Chair Name: _________________________ Date of Review: ________________ Page 3of 3 Review by Dean Name: _________________________ Date of Review: ________________ Received by Provost Name: _________________________ Date of Receipt: ________________