Report on Outside Studies Program		         				Form 19.04c
Staff Member to Complete:				  		 Macquarie  University 9 February 2002

NB: This Report should be submitted within SIX months of the completion of the Program.  If it is not, a reminder will issue from the Head and the next Program may be deferred if the report is not then submitted.

Division: ________________________________   Department:   __________________________________________

Family Name:  _______________________________   Other Names: ______________________________________ 

Title: ________ 	Employee Number:  ________________	Extension Number:  __________

Period of Studies Program: 	from   ____ / ____ / ____   	to   	____ / ____ / ____

Is this Report being submitted late:		 Yes	p		No    p
Major Activities and Locations:   

Major Outcomes:   

Benefits for Future Teaching and Research:       

Benefits for the University

Comparisons with other Universities (e.g. standards, programs, procedures, facilities):

Staff Member’s Signature:  _________________________________ 	      ___ / ___ / ___
										Date
				Report on Outside Studies Program		  	Form 19.04c
											   Page 2 of 2
Adviser - for comment:

Adviser’s Signature:  _______________________________ 	   		   ___ / ___ / ___
											Date
Head of Department (if not Adviser) - for comment:

Head of Department’s Signature:  _______________________________ 	      ___ / ___ / ___													Date         
Head of Division - for comment and Acceptance:

If Report submitted late is the next Program to be deferred?  No p Yes p by    ______ months	
Report accepted p 	 	OR 	      Further information required as in comments  p 

Follow-up action initiated where required:  p

	 _________________________________________  	 	 ___ / ___ / ___
			Head of Division					Date
Personnel Office Use Only:
p Original Report returned to Head of Division for filing and copy sent to Staff Member:   				 
p Copy of Report sent to Deputy Vice-Chancellor Academic for information:    
p Copy of Report placed on Personal File:		  				  
p Amended  OSP Confirmation Form 19.04d sent to Staff  Member and copy sent to Head of Division
  
Processed by:	________ (inits) 	 	 ___ / ___ / ___