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[{"$nulls":4},"UNIVERSITY OF CALIFORNIA ",null,null,"1. CAMPUS","2. EMPLOYEE ID#","3. DATE"]
[{"$nulls":4},"SABBATICAL LEAVE "]
[{"$nulls":4},"SPECIAL LEAVE OF ABSENCE",{"$nulls":7},"A  ACADEMIC"]
[{"$nulls":12},"S  STAFF "]
[null,"4. NAME (Last, First, Middle Initial)           ",{"$nulls":5},"5. PERSONNEL PROGRAM CODE",{"$nulls":4},"P A&PS"]
[{"$nulls":12},"M  MAP"]
[null,"6.  ADDRESS WHILE ON LEAVE           ",{"$nulls":5},"7. DEPARTMENT",{"$nulls":4},"E EXECUTIVE"]
[]
[{"$nulls":7},"8.  TITLE"]
[null,"(TO CHANGE W-2 OR CHECK ADDRESS -- USE FORM UPAY 544)"]
[]
[null,"9. TYPE OF LEAVE"]
[null,"SABBATICAL",{"$nulls":4},"LEAVE OF ABSENCE",{"$nulls":5},"04  CHILDBEARING"]
[null,"(COMPLETE SECTIONS A, C, D)",{"$nulls":4},"(COMPLETE SECTIONS A AND B)",{"$nulls":5},"05  EXTENDED ILLNESS"]
[null,"REGULAR",null,"            IN RESIDENCE",{"$nulls":8},"06  GOVERMENT PUBLIC SERVICE"]
[null,"FULL SALARY","              PARTIAL SALARY               FULL  SALARY        ",null,null,"PARTIAL SALARY",{"$nulls":6},"07  PROF DEVELOPMENT"]
[{"$nulls":12},"08 PERSONAL"]
[{"$nulls":12},"09  WORKERS COMPENSATION"]
[null,"10. PAY PERIOD",null,null,"BEGIN DATE","RETURN DATE","11. ACADEMIC YEAR","SUM  ","FALL       WINTER","SPR",null,null,"10  FURLOUGH"]
[null,"OF LEAVE",{"$nulls":4},"SERVICE QUARTERS AFFECTED",{"$nulls":5},"11  MILITARY"]
[{"$nulls":12},"12  SPECIAL RESEARCH"]
["A","12.  REASON FOR A SPECIFIC PURPOSE OR PROPOSED LEAVE (SABBATICAL: INCLUDE LOCATION WHILE ON PROPOSED LEAVE)",{"$nulls":10},"13  ADMINISTRATION"]
["LEAVE SUMMARY",{"$nulls":11},"99  OTHER"]
[]
[]
[null,"13.  OTHER SOURCES OF INCOME WHILE OF LEAVE (SABBATICAL: INDICATE NATURE AND AMOUNT OF ALL INCOME)",{"$nulls":10},"SUMMER"]
[{"$nulls":12},"FALL"]
[{"$nulls":12},"WINTER"]
[{"$nulls":12},"SPRING"]
[null,"14. ARE YOU A PRINCIPAL INVESTIGATOR -- Name of Substitute",{"$nulls":3},"15. HAS SPONSORING AGENCY APPROVED SUBSTITUTE?",null,null,"16. NOTE FOR SABBATICAL LEAVE:  Indicate in Program Leave Statement arrangements made for continuation and supervision of extramurally sponsored research."]
[]
[]
[null,null,"YES"," NO"]
["B","17. DISPOSITION OF WORK WHILE ON LEAVE:"]
["LEAVE OF ABSENCE"]
[]
[null,"18. U.C. COMPENSATION WHILE ON LEAVE:",{"$nulls":4},"Percent time","19.  IS THIS AN EXTENSION OF A PREVIOUS LEAVE?"]
[null,"NO SALARY           FULL SALARY",{"$nulls":3},"OTHER",100]
[]
["C","20. I hereby certify that I have read the Standing Order of the Regents and the Regulations of the President governing the award of sabbatical leaves, and that I shall accept the requested leave, if granted, under the conditions set forth in these regulations and shall continue my service at the University following said leave for a period of at least equal to the period of the leave.",{"$nulls":5},"     EMPLOYEE SIGNATURE               DATE"]
["SABBATICAL LEAVE"]
["D","21. IF APPLICANT ON MEDICAL SCHOOL COMPENSATION PLAN SHOW PROPOSED SALARY DISTRIBUTION WHILE ON LEAVE:",{"$nulls":4},"Percent time","22.  IF NECESSARY TO EMPLOY SUBSTITUTE WHAT ADDITION TO DEPARTMENT BUDGET IS REQUIRED?"]
["DEPARTMENT CHAIRPERSON FOR SABBATICAL LEAVE",{"$nulls":5},100]
[null,"23. IF LEAVE IS GRANTED, WHAT DISTRIBUTIONS IS TO BE MADE OF APPLICANT'S CLASSES?"]
[]
[]
[null,"24.  IF IN RESIDENCE IS REQUIRED WHAT COURSES AND HOURS PER QUARTER TO BE TAUGHT BY APPLICANT?"]
[{"$nulls":3},"HOURS:",null,null,"HOURS:",null,null,"HOURS:"]
[null,"QUARTER",null,null,"QUARTER",null,null,"QUARTER"]
[null,"COURSES:",null,null,"COURSES:",null,null,"COURSES:"]
[null,"NAMES:",null,null,"NAMES:",null,null,"NAMES:"]
[null,"DOES APPLICANT HAVE FULL RESPONSIBILITY FOR COURSES?",null,null,"DOES APPLICANT HAVE FULL RESPONSIBILITY FOR COURSES?",null,null,"DOES APPLICANT HAVE FULL RESPONSIBILITY FOR COURSES?"]
[]
["REMARKS","25. Sabbatical Credit Balance"]
[]
[]
[]
["APPROVAL","PREPARED BY:",null,null,"PHONE NO.",null,"EMPLOYEE",null,null,"DATE"]
[]
[null,"DEPT CHAIRPERSON                    DATE",{"$nulls":3},"DEAN                                                                 ",null,"DATE","PERSONNEL             ","DATE"]
[]
[{"$nulls":5},"EXECUTIVE DEAN",null,"DATE","CHANCELLOR","DATE"]

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