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Applicant's section

Grant-In-Aid Educational Leave Award Program
Application Form

Application Deadline: Monday, March 13, 2023 by Noon

Departmental Replacement Funding
The replacement funding to be appropriated to a recipient’s department for each full-time award is up to $5,000 for a Faculty or A&P award and up to $3,000 for a SP award, depending on funding availability.

Please ensure that your application has the following attachments to complete this form:

Resume
Three letters of recommendation
Personal Statement
All transcripts. Unofficial transcripts may be provided with the application. Official transcripts must be provided if the applicant is selected to receive an award.

Full Name*

First Name

Last Name

UIN*

Job Title*

Department*

Employment Category*

Faculty A&P Support Personel

Applicant's Email*

Supervisor's Email (If Staff - Supervisor/If Faculty - Dean)*

Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Year and semester(s) for which Grant-In-Aid Education Leave is Requested (choose one):*

Full-time Fall Full-time Spring Part-time Fall & Spring Part-time Summer & Fall Part-time Spring & Summer

Summer Leave may be awarded on a case-by-case basis. To be eligible to receive Summer Leave, applicants must be enrolled by May 15th. Please include details about Summer Leave in your personal statement.

Name(s) of State of Florida or other regionally accredited university/college you will attend during the Educational Leave Program: *

Educational Objective:*

Associate Bachelor Master Doctoral

Field of Study*

Total number of semester hour credits remaining to complete degree (including internship):*

Anticipated completion date of degree (term & year):*

Grant-in-Aid applicants must have at least two years of satisfactory performance in a permanent or continuing full-time position prior to the beginning of the academic year in which the grant will be awarded. Please enter the date you started working at FGCU:*

I understand that if I am awarded an educational leave under this program, I am expected to continue employment with Florida Gulf Coast University for one calendar year following the completion of the educational leave. I agree to execute a Promissory Note agreeing to repay the prorated amount of my gross salary and any stipends paid to me during my educational leave if I resign or if I am terminated from my employment with Florida Gulf Coast University before the one-year period ends.

If selected for participation in the Grant-In-Aid Educational Leave Award Program, I agree to participate in any follow-up assessments conducted by the administrators of the program and assist with any other requests that may be necessary to facilitate the administration of the program. I certify that the information provided is true and accurate.

Certification that information is true & accurate:*

I agree I do not agree

Signature*

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Use your mouse or finger to draw your signature above

Date*

The employee’s supervisor must also sign the application. The signature of the supervisor indicates that they are aware of the employee’s application for the award and supports the leave if it is awarded. It is the supervisor’s responsibility to inform the person that is directly responsible for managing the department/unit (Dean, Director or Department Head) of this application. The supervisor confirms that the applicant currently has a minimum performance evaluation rating of “Meets Expectations”.

Please prepare a personal statement for the selection committee to review and discuss the following:

Diversity and inclusion are important values to FGCU. Discuss what diversity and inclusion mean to you and how you promote those values at FGCU.
Outline your remaining requirements for the completion of your degree.
How does the completion of your degree relate to your career and goals at FGCU?
How does the completion of your degree benefit FGCU?
Discuss some of your professional accomplishments during your employment with FGCU.
What is your biggest accomplishment and how did it impact the University?

Personal Statement*

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