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Please complete this form for the Head of Department’s consideration (please check your departmental procedures on the webpages/intranet for information on submitting completed forms within department), and ensure it is sent on to (MPLS Academic Appointments and HR Officer).

Name of applicant: 



Leave applied for (please complete (A) OR (B), as appropriate):

A.      Applicants other than CUF lecturers


OR (clinical & curatorial staff only): Period (dates): No. of months:

B.     CUF lecturers

Number and topics (if known) of courses of eight lectures or classes from which dispensation is sought; if topics are not yet known, state the subject area in which you usually lecture:

For which academic year(s) is dispensation sought? 

Purpose of Leave (including any ‘outside’ appointments, research fellowships, etc.)

It is particularly important to refer to any consultancy held during leave as the University expects to issue a disclaimer of liability in such cases (and to see a copy of the proposed contract if this does not conform to the University’s standard form, a copy of which can be supplied).

College leave

(Colleges operate their own procedures for approval of leave from college duties. Therefore, it is assumed that you have applied to your college as necessary for the leave you wish to request, and that you have ensured that there will be no teaching or other difficulties on the college side if the university leave is granted.)

Please specify which terms you have applied for or been granted leave for and delete whichever status is inappropriate.

(Paid) Term(s): Granted/Applied for/Not applicable

(Unpaid) Term(s): Granted/Applied for/Not applicable

Please specify which terms you have applied for or been granted leave for and delete whichever status is inappropriate.

Buyout/other periods of leave  

Please detail any periods of buyout or special leave (excluding annual/ maternity/sickness leave) since your last period of sabbatical.

Substitute teaching

Please outline any arrangements you have made for substitute teaching under the body to whom you are responsible for your teaching duties, in the form of:

  • Lectures
  • Classes
  • Marking & other teaching-related activity. (Please outline any arrangements you have made for setting exams and for marking under the body to whom you are responsible for your teaching duties. Please provide any suggestions you may have for the marking of e.g. essays and projects in your absence.)

Do you normally provide teaching for any other body apart from your college or department above, which might therefore need to consider substitute arrangements during your leave?  Yes/No

If yes, please comment under the heads referred to above. 


Have you already accepted nomination as a public examiner during this period? Yes/No

If yes, would you still be able to act if leave were granted? Yes/No

A person whose duties include the duty of acting as examiner or assessor is required so to act ‘as and when requested to do so by a nominating committee or other competent body … unless he or she can show reasonable cause, to the satisfaction of the Vice‑Chancellor and Proctors, why on a particular occasion he should not do so’. Such persons who have already accepted nomination but who wish not to act during sabbatical leave must therefore make separate application to the Proctors as soon as possible, since no application for leave or dispensation will be approved in such cases until the application for release from the examining obligation is resolved. 

Supervision of graduate students

Do you intend to continue supervising your graduate students during the leave?  Yes/No

If no, please confirm that alternative arrangements are being/have been formally approved. 


Have you made any arrangements to cover any of your administrative responsibilities? Yes/No

Please detail any arrangements made. 

Signed and dated by the Applicant

On completing the form, pass it to your Head of Department for consideration, and ensure it is then sent on by the department to or Polly Bunce, MPLS Division, 9 Parks Road.

After you have returned from leave we will ask you for a brief report on activities undertaken during the leave. We will also send you a form asking you to consider whether you are better off financially than if you had not taken leave and, if so, what part of your normal university stipend in respect of the period covered by the leave you will forgo (see Statutes, 2000, pp. 372‑4).



Statement to be completed by the head of the department

To be completed where the applicant has teaching etc. duties under the direction of the head of department.

I confirm that the arrangements for substitute teaching (and for other duties within the department) are satisfactory.

Teaching will:

(a)           be covered by the department without cost/the cost to be met from departmental funds;


(b)           (exceptionally) require a sum of (amount in £) from other funds, i.e. (number of) lectures at (cost) each (plus expenses) and/or (number of) hours of demonstrating at (cost) per hour, because this cost cannot be met from the department’s resources.

Departmental Approval (Head of Dept and/or Head of Sub-Dept):


Printed name: