Application for
Long Term Research Leave

1 Details of Applicant:  ______________________________

School: ____________________________ Position: ___________________________

Dates of proposed leave: __________________________ to _____________________

Date of first appointment to UPNG: _________________________________________

Date of termination of current contract: ______________________________________

Previous medium-term and long-term research leave:

from ______________ to ___________;

from ______________ to ___________.

from ______________ to ___________.

Home as defined in contract: _______________________________________________

2 Previous URPC grants (last 5 years):

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3 Research program objectives and methods:

4 Relationship of Leave Objective to School/Centre’s Strategic Operational Plan:

5 Benefit of program to the University and PNG:

6 Travel schedule:

7 Financial support:

8 Applicant’s signature: ______________________            Date: ________________

9 Approvals (indicate by signature):

Signature of Executive Dean: ____________________            Date: ________________

Comments (note if teaching and administrative duties are covered)

10 Approval by University Research and Publications Committee:

Signature of Chair: _____________________________       Date: ________________

NOTE: Type and submit multiple copies of the completed form to URPC. This form is a guide;
use additional pages as necessary.