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

Note: Evaluations from current academic year are not to be included.

 

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      
Academic Year (______ - _______)  _______ Yes _______ No      
Academic Year (______ - _______)  _______ Yes _______ No
If Applicable:
Academic Year (______ - _______)  _______ Yes _______ No      
Academic Year (______ - _______)  _______ Yes _______ No        
 
 
III.  Teaching and Related Activities/ Academic Support (All Applicants)
 
Minimum number of instances for at least three of the five preceding applicable academic years:  
Assistant Professor - 4 instances; Associate Professor – 6 instances; Professor – 6 instances
 
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
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 and relate to the goals agreed upon each year on the Preliminary Evaluation Agreement Forms? Documentation for other accomplishments and contributions may also be included. Note: Evaluations from current academic year are not to be included.
 

IV.  Service to Students, Department, Division, and College (All Applicants)
 
Minimum number of instances for at least three of the five preceding applicable academic years, 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: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
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  relate to the goals agreed upon each year on the Preliminary Evaluation Agreement Forms? Documentation for other accomplishments and contributions may also be included. Note: Evaluations from current academic year are not to be included.

_______ Yes _______ No

V.  Professional Service and Development (All Applicants)
 
Minimum number of instances for at least three of the five preceding applicable academic years:
Assistant Professor - 2 instances; Associate Professor – 6 instances; Professor—6 instances

Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
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 relate to the goals agreed upon each year on the Preliminary Evaluation Agreement Forms? Documentation for other accomplishments and contributions may also be included. Note: Evaluations from current academic year are not to be included.

 

VI.	Leadership and/or Sharing of Experience (for Rank of Professor only)

Minimum of 3 instances for at least three of the five preceding applicable academic years:  

Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
Academic Year (______ - _______) Instance: ___________________________________________________
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 relate to the goals agreed upon each year on the Preliminary Evaluation Agreement Forms? Documentation for other accomplishments and contributions may also be included. 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      

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