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.
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)
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.
_______ Yes _______ No
Form 2321/004 (8/21) (page 1 of 3)
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.
_______ Yes _______ No
Form 2321/004 (8/21) (page 2 of 3)
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
Form 2321/004 (8/21) (page 3 of 3