2011 Sabbatical Leave Application Form

Please answer all the questions. Applications close Friday 2 July 2010.

Which Sabbatical Scheme are you applying for? (Please tick one):

Area Principal (APS) Primary Principal (PPS) Secondary Principal (SPS)

Area Teacher (ATS) Primary Teacher (PTS) Secondary Teacher (STS)

Personal Details

First Name: Surname:

Address:

Town/
City: Postcode:

Contact
numbers: Home/Mobile: Work:

Email
Address:

Statistical Information

Gender: Male Female Date of Birth: / / Ethnicity:

Teaching Information
MOE Employee Number: Teacher Registration Number:
(on your payslip):

Registration status: (Please tick one) Full (F) Subject to Confirmation (STC) Provisional (P)

MOE School Number: School:

Current Position: Total years of completed teaching service:

Are you a: Permanent Employee Fixed Term Employee Are you: Full time (FT) Part time (PT)

From To Institution Position Held

Employment
History**:

Details of Previous Leave Taken

Years of continuous service (calculate from the end of this year back to the last significant previous leave date, if any)*:

Details of previous leave taken**:

Please include any leave of more than Date School Length of Leave (days) Purpose
one term duration, with or without pay,
for the purposes of refreshments, study,
research, school visiting or attendance at
courses

*Please check the relevant guidelines for the minimum level of unbroken service required to be eligible for this award. Periods of childcare of up to 4 years or sick leave of
less than 6 months will not count as broken service.
** Please add extra A4 sheets if necessary
Sabbatical Propos
Proposal
roposal Requirements
Requirements

Principals Only: Please submit your proposal under the following headings.

1. Purpose

2. Programme Outline

3. Time Commitments of Sabbatical

4. Benefits

i. Links to issues important to the school

ii. Links to the school’s strategic or annual plan

iii. Links to personal and professional development

iv. Links to current schooling sector priorities

5. Costing Schedule

6. Reporting Intentions

Your proposal will be evaluated for the purpose of selection of successful applicants. Please see the relevant Sabbatical Leave Scheme: Guidelines for
Applicants for 2011 document for guidance.

Teachers Only: Please submit your proposal under the following headings.

1. Professional learning activities that will be undertaken during the Sabbatical (please describe activity)

2. Estimated time commitments of these activities during Sabbatical

3. Expected benefits of the Sabbatical for:

i. Self

ii. Students I Teach

iii. School

4. Reporting Intentions

Your proposal will be evaluated for the purpose of selection of successful applicants. Please see the relevant 2011 Sabbatical Leave Guidelines
document for more information.

Principals and Teachers to fill in: Term for which the leave is sought (e.g. Term 2)

The personal information on this form is being collected for the purpose of considering your application for a Sabbatical Award. If your application is
successful, your information will be used for the purpose of administering the award. The information collected will be held by the Ministry of Education
and used for statistical and research purposes. This may be shared with the following agencies for this purpose: NZSTA, PPTA and/or NZEI as applicable.
You have the right to access and request correction of this information.

Declaration

In making this application, I certify that the information given is true and accurate and complies with the eligibility criteria.
I understand that if successful, this award provides me with leave on full pay for a specified period from my current permanent position in a state
school, and does not entitle me to any other benefits or expenses.
I accept that the decision of the selection panel is final, and that no correspondence will be entered into.

Applicant’s Signature: Date:

/ /
Principal’s Signature: Date:
/ /
The Board of Trustees will approve leave with pay, should an offer be made. (If this approval has not been sought or given, please provide an
explanation.)
Board Chairperson’s Signature: Date: / /

Note for the Board Chairperson: In signing this application, this board signature confirms any permissions associated with approving this application have been
agreed to by the Board of Trustees.

Send one unbound copy of your completed application to:

Teacher Study Awards, TeachNZ, Ministry of Education, PO Box 1666, Wellington, 6140

Please note: Faxed or emailed applications cannot be accepted. Applications must be postmarked no later than Friday 2 July 2010.
For enquiries contact TeachNZ Call: 0800 165 225 Email: teacher.studyawards@minedu.govt.nz Web: www.teachnz.govt.nz/studyawards