I hereby apply for the Phi Kappa Phi Mary Todd Sabbatical Award and, if selected, specifically agree to comply with the following stipulations and understand that failure to do so may result in the withdrawal of the award:
To provide documentation of approval of sabbatical/leave from my institution.
To submit a high-resolution color photo and brief biographical description for publicity purposes, which may include, but is not limited to, press releases, advertisements, Phi Kappa Phi publications both print and electronic, and any other venue used to promote and educate about The Honor Society of Phi Kappa Phi and/or its award programs.
To pursue the proposed sabbatical plan as described in my application, unless prior approval of changes in my plan is secured from the national office.
To submit a summary report to the national office within 60 days of the end of the award period that describes the outcomes of the sabbatical/leave, whether the outcomes were met, and how these outcomes have been documented. The report should also contain information on how the new knowledge will be utilized in continuing his/her institutional responsibilities.
I understand that The Honor Society of Phi Kappa Phi assumes no responsibility, obligations, or liability whatsoever beyond providing the amount of the award.
I understand that should I be unable to accept the award for any reason, Phi Kappa Phi reserves the right to award another applicant.
I have examined this application and certify that all information given in it is complete and accurate to the best of my knowledge.