Stipend/Course Release Agreement

(Not to be used for grant funding buyout, Program Coordinators, or Block/Residency Coordinators)

Faculty Name *

Faculty Email *

Semester/Year *

Course Release / Stipend *

Course Release

Stipend

Course release will be paid with funds from: *

Departmental Funds

Existing Initiative (e.g. Charles Butt Foundation)

Unsure

Existing Initiative

Project Description

Description of Work *

Curriculum Development

Fellowship

Extraordinary Project (e.g. Living Learning Community)

Other

Other *

Project Goals *

To accomplish these goals, list achievable activities that will be completed during the semester granted. Provide a sufficient description of activities and estimate of time to constitute a 15-week semester: *

State significance/magnitude of the project (Explain why a release or stipend is required instead of ordinary responsibilities or faculty service): *

If course release is granted, indicate which course(s) from which you would be released and how it/they will be covered: *

If not applicable, write N/A

Upon Completion

List deliverable(s) you will you produce/create/maintain that contribute to program/department/university goals: *

By submitting this form, I understand that if my request is granted, I may need to submit documentation of semester's work to dept. chair by the last class date before finals.

If you happen to see this, do not fill this field.