ࡱ> g ybjbj 4t jt j,1OOOOOccc8ce2!!(!!!"R#,~#$d&d&d&d&d&d&d$CiknJdO#""##JdOO!!d(((#RO!O!$d(#$d((O ]!(+#0[&dd0e[gl%glL]glO]D##(#####JdJd '###e####gl#########Y : ACADEMIC DEVELOPMENT PROGRAM 2025 Application to undertake an ADP within 2026. A short CV per the Website proforma, your Research Activity Statement (obtained via adp@westernsydney.edu.au) and any supporting documentation should accompany this application. Please note this is a Word document, which will expand as you type in the information and must be submitted as a word document to  HYPERLINK "mailto:adp@westernsydney.edu.au" adp@westernsydney.edu.au Please do not amend this form. 1 PERSONAL DETAILSTitle:Employee ID:First Name: Surname: Gender: & Woman & Man & Prefer to not say & I identify my gender as: Current Position: Academic Level:Do you identify as Aboriginal and/or Torres Strait Islander: (NOTE: if yes a report will be sought for your application per the Guidelines)( Yes ( No ( Prefer to not identifyDoes this application include a significant contribution to Westerns Indigenous Strategy: (NOTE: if yes a report will be sought for your application per the Guidelines)( Yes ( No School/Institute/Unit: & Commencement date at Western: & Fixed Term (Contract End Date: __/__/__Full time / Fractional appointment: %Have you participated in the Academic Work Planning and Career Development Review Process? Yes / No Have you discussed your development proposal with your Dean prior to submitting this application? Yes / No Do you have a current signed workload agreement? Yes / NoDoes this program relate to your Professional Development Plan as discussed with your Academic Supervisor? Yes / NoHave you held a significant governance role within the last 3 years such as APA, DAP, Other? Yes / No If yes, what was your role and workload: How long have you been in this role:  Current and past work profiles at Western as a percentage: (display as a total of 100% based on your signed workload agreements from the last full three years, commencing with the current year):Year2025Learning & Teaching Research & ScholarshipEngagement, Governance & Service Year2024Learning & Teaching Research & ScholarshipEngagement, Governance & Service Year2023Learning & Teaching Research & ScholarshipEngagement, Governance & Service Aggregated Work Profile as a percentage: (display as a total of 100% based on your above work profiles averaged over the number of years - refer to the guidelines for instructions)Learning & TeachingResearch & ScholarshipEngagement, Governance & Service  2 DETAILS OF LAST ADP (only to be completed if you have undertaken a previous Academic Study Leave program) Dates of last ADP/PDP (or equivalent) From: / / To: / / What were the objectives of your last ADP? List specific academic contributions and outcomes arising from your last ADP. Please attach your previous ADP report with your application. 3 Achievements Relative to Opportunity refer to the Guidelines for further details and information. 250 words maximum in each section below. EQUITY CONSIDERATIONS Please outline any significant equity considerations which are relevant to this application and have constrained your academic opportunities over the past five years OR during the time period covered by this application. (250 words maximum) Describe the impact these equity considerations have had on your academic achievements. (250 words maximum) Other Considerations including Natural Disaster/Global Events/Pandemics Please outline any other considerations of significance which are relevant to this application and have constrained your academic opportunities over the past three years. (250 words maximum) Describe the impact these considerations have had on your academic achievements. (250 words maximum)  4 PROPOSED ADP DATES TIMEFRAME REQUESTED: Proposed period of absence (maximum 22 weeks) with impact on only one teaching period: 22 week block period q 2 x 11 week block periods (to be taken over a 2-year period) q 3 x 7 week block periods (to be taken over a 2-year period) q From ___________________ To _______________________ Date Date PROPOSED ANNUAL LEAVE: Employees must take any annual leave accrued (minimum 2 weeks) during the period of ADP, either during or immediately before or upon completion of the ADP. Employees may apply for four weeks annual leave or long service before, during or after an ADP. Annual Leave q From: To: Long Service Leave q From: To: Leave without Pay q From: To: (except in circumstances such as family/carers' responsibilities, maternity or illness/disability). This period of ADP would be spent: (tick as appropriate) In Australia q Overseas q List name(s) of country(s) and dates: Both q List name(s) of country(s) and dates:  5 DETAILS OF PROPOSED ADP AND EXPECTED OUTCOMES Address the nature of your ADP proposal (e.g. pursuit of research, scholarly work, teaching development, professional engagement, completion of PhD study etc.) within the following sections. Please refer to the Guidelines for supporting information. Section 5 should be no greater than 3 pages in total. The breakdown of my program:Develop, improve or progress research, including reorientation and recommencing a program of research Establish or enhance learning and teachingIndustry/EngagementCompletion of a PhD__%__%__%__% ADP Summary: Please provide a 100 word summary of your proposed program outlining what you are doing and what you hope to achieve (your proposed outcomes). (Note: This summary may be used with the outcome notification of ADP Applications and for other promotional activities if successful.)  5a. ADP for the purposes of PhD Completion. (Leave blank if not relevant, if you complete this section please skip to section 9) University of Enrolment:Name of Supervisor (s):Title of Thesis:Submission Date:Provision of a detailed timeline by month outlining the progress required for completion of the PhD by the end of the ADP to be attached. This timeline should include the lead up period to the ADP. 5b. Your program objectives (ie what are you going to do? Include planned conference attendance and if your program is connected with an ongoing funded project.) Please limit to two pages.  5c. What are the specific outputs that you plan to achieve during your program and how will they benefit both yourself and the University. How will your outcomes be measured? Include publications, books, grant submissions. (ensure your outcomes are clear and demonstrate how they will assist with your career development)  6 ITINERARY Proposed Program: This should be as detailed as possible and should provide a clear timeline of the activities to take place. Please attach confirmation of your arrangements from the institution(s) / organisation(s) named. This should include the name of the person supporting the visit, possible co-workers during the leave period and evidence of invitation to be a presenter, visiting scholar, etc. If you are waiting on this documentation attached the relevant emails to demonstrate communications initially. Ensure you include planned conference attendance and details. Location Details - Name of Organisation/Institution & Name of person supporting the visit, OR details of location if remaining at Western  Period of Attachment/Activity  Activities to be Undertaken while on Attachment (This should clearly detail the activities being undertaken in a concise timeline)   7 ESTIMATES Note: The limits of financial assistance from the University are shown in the ADP Guidelines and are funded by the relevant School/Unit: TOTAL COSTS OF ADP (Please include full details and estimated costs under each heading below) Travel: $ Accommodation: $ Fees: $ Dependants (if applicable): and see below $ Other: $ TOTAL $ Amount of financial assistance sought from the University $ Amount of financial assistance sought from research funds $ Cost Centre: Project Code: Delegation holder: If claiming any dependants, please list names and include the ages of children as at 1 January 2026. The financial assistance grant is awarded with the expectation that no further funds will be sought from the School, Research Institute or other University unit for the duration of the ADP. Daily per diem expenses do not form part of the financial assistance towards undertaking ADP. Requests for additional funding in exceptional circumstances must be submitted in writing to the relevant Dean or Research Director providing full details of where funds are available to draw on. Failure to notify the Dean or Research Director will normally result in the repayment of any financial assistance grant. 8 HDR Supervision during ADP Please provide details of HDR students for whom you will be the supervisor at the time of commencement of the proposed ADP, and attach written confirmation from co-supervisors that they will take on a prominent supervisory role during your ADP. NOTE: imminent completion of a HDR student during the ADP timeframe may require the supervisory status to remain and this should be noted. Name of StudentDegreeExpected Date of Completion Supervisory arrangements during ADP name of proposed Principal SupervisorStudent consulted and supportive of Supervisory arrangements Publication of outcomes/applications: If successful I understand that my brief 100 word summary may be published within the University for ADP promotion purposes.  Yes/No If successful and deemed suitable by the ADP Committee I agree for aspects of my ADP Application to be de-identified and utilised for future applicants as a training tool. This will be approved by myself prior to utilisation.  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Yes/No  9 EMPLOYEE DECLARATIONI have read the ADP Policy and Guidelines and understand the obligations imposed by the Policy and Guidelines should my application be successful. The information provided in this application is an accurate representation, and I undertake to: Return to the University after the period of ADP and complete a period of equivalent service to the period of ADP taken. Act in good faith and abide by University policies and guidelines whilst on ADP. Submit a comprehensive ADP report within one (1) month of concluding such leave. Provide a seminar on the outcomes of the program to my School or other appropriate forums including Research and/or Teaching Weeks. Complete and not vary the proposed ADP program unless prior University approval has been granted. Discharge all required responsibilities and duties to the satisfaction of the academic supervisor prior to departing on ADP. 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