Cattell

The James McKeen Cattell Sabbatical Award
Institution Certification Form

Name of Applicant ________________________________________________________

Institution _______________________________________________________________

Academic Rank ___________________________________________________________

Certification Completed by (Name, Title): ______________________________________

1. Is the applicant a tenured member of
the faculty of your institution?_____________________________
2. Will the applicant be eligible for a
sabbatical under your standard procedures? _
3. What is the applicant's salary for the
present academic year?
4. What payment does your institution make
to a faculty member on sabbatical leave? __

5. Does your institution cover completely the
fringe benefits of a faculty member on sabbatical leave? __________________
6. If the answer to the previous question is "No,"
what benefits are not covered, and what is the dollar value of each? _
______________________________
(your signature or typed name if sent by e-mail)

Instructions:
Mail completed form by December 1 to:
Christina L. Williams, Secretary
James McKeen Cattell Fund
Department of Psychology: Experimental
Box 90086
Duke University
9 Flowers Drive
Durham, NC 27708-0086