COLLEGE COMMITTEE INDIVIDUAL RECOMMENDATION FORM
To be used by College Committee Members
1. Minimum number of instances over three-year period:
2. _______ Yes _______ No
IV. Service to Students, Department, Division, and College (All Applicants)
1. _______ Yes _______ No
V. Professional Service and Development (All Applicants)
1. Minimum of 3 instances over a three-year period.
2. _______ Yes _______ No

COLLEGE COMMITTEE INDIVIDUAL RECOMMENDATION FORM

To be used by College Committee Members

Applicant’s Name_____________________________________________________________
Division_____________________________________________________________________
Applying For_________________________________________________________________
Date of Last Promotion (or Hiring) ________________________________________________

I. Supervisor Evaluations: (must be “4” or “5” for all three years)

*Note*: Evaluations from current academic year are not to be included. Former LTC Region 1 faculty must have received “Exceeds Expectations” or “Outstanding” on former LTC supervisor evaluations for 2009-2010.

Academic Year (______ - _______)
	Rating___________
Academic Year (______ - _______)
	Rating___________
Academic Year (______ - _______)
	Rating___________

II. Preliminary Evaluation Agreements (check ‘yes’ or ‘no’ if included in packet)

Academic Year (______ - _______) _______ Yes _______ No ______N/A*

Academic Year (______ - _______) _______ Yes _______ No

*N/A = Not applicable -Former LTC Region 1 Faculty Member for 2009-2010.

III. Teaching and Related Activities/ Academic Support (All Applicants)

Minimum number of instances over three-year period:

Assistant Professor - 4 instances; Associate Professor – 6 instances; Professor – 6 instances

Academic Year (______ - _______) Instance: ___________________________________________________

Comments: _______________________________________________________________________________

_________________________________________________________________________________________

Does the documentation indicate annual participation in activities that examine, improve, and/ or support instruction according to the criteria indicated for the desired rank? Note: Evaluations from current academic year are not to be included.

_______ Yes _______ No

Form 2321/004 (8/12) (page 1 of 3)

IV. Service to Students, Department, Division, and College (All Applicants)

Minimum number of instances over a three-year period, which includes at least 1 instance at the college-wide level :
Assistant Professor - 4 instances; Associate Professor – 6 instances; Professor – 6 instances

Academic Year (______ - _______) Instance: ___________________________________________________

Comments: _______________________________________________________________________________

_________________________________________________________________________________________

Does the documentation indicate annual participation in activities of service to students, department, division, and College according to the criteria specified for the desired rank and according to the goals agreed upon each year on the Preliminary Evaluation Agreement Forms? Note: Evaluations from current academic year are not to be included. Former LTC Region 1 faculty members are unable to include or refer to Preliminary Evaluation Agreements for 2009-2010; they must, however, document their participation in the required categories for 2009-2010.

_______ Yes _______ No

V. Professional Service and Development (All Applicants)

Minimum number of instances over a three-year period:
Assistant Professor - 2 instances ; Associate Professor – 6 instances; Professor—6 instances

Academic Year (______ - _______) Instance: ___________________________________________________

Comments: _______________________________________________________________________________

_________________________________________________________________________________________

Does the documentation indicate annual participation in professional service and/or development activities according to the criteria specified for the desired rank and according to the goals agreed upon each year on the Preliminary Evaluation Agreement Forms? Note: Evaluations from current academic year are not to be included. Former LTC Region 1 faculty members are unable to include or refer to Preliminary Evaluation Agreements for 2009-2010; they must, however, document their participation in the required categories for 2009-2010.

_______ Yes _______ No

Form 2321/004 (8/12) (page 2 of 3)

Attachment D (continued)

VI. Leadership and Sharing of Content Area and/or Instructional Expertise with Colleagues (for Rank of Professor only)

Minimum of 3 instances over a three-year period.

Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________

Comments: _______________________________________________________________________________
_________________________________________________________________________________________

Does the documentation indicate at least three examples of participation in leadership activities or in activities designed to share expertise with colleagues according to the criteria specified for this rank and according to the goals agreed upon each year on the Preliminary Evaluation Agreement Forms? Note: Evaluations from current academic year are not to be included.

_______ Yes _______ No

If the portfolio satisfactorily meets all of the above criteria, the applicant is eligible for promotion to the desired rank. Please indicate whether you agree that the requirements for promotion to the next rank have been met according to the documentation in this portfolio.

______________________________________________ __________________________
Signature of Committee Member Date

If the criteria for any one of the above categories have NOT been satisfactorily met, or if the documentation for that category is insufficient, the applicant is NOT eligible for promotion at this time. If such is the case, please indicate reason or reasons for denying promotion:

______________________________________________ ___________________________
Signature of Committee Member Date

Form 2321/004 (8/12) (page 3 of 3)

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VI.	Leadership and Sharing of Content Area and/or Instructional Expertise with Colleagues (for Rank of Professor only)