Submit One Copy GS Form #10 (11/15) UNIVERSITY OF SOUTH ALABAMA THE GRADUATE SCHOOL REQUEST FOR APPOINTMENT TO ASSOCIATE MEMBERSHIP ON THE GRADUATE FACULTY APPLICANT _____________________________________________________ ______________________ NAME DATE _______________________________________________________________ ___________________________ COLLEGE TELEPHONE _______________________________________________________________ ___________________________ DEPARTMENT CAMPUS ADDRESS (Bldg/Rm) _______________________________________________________________ E‐MAIL (applicant completes second page) Vote of the full and associate members of the graduate faculty in the department: #______for, #______against associate membership RECOMMENDED: _______________________________________________________________ _________________________ DEPARTMENT CHAIR DATE _______________________________________________________________ ________________________ COLLEGE DIRECTOR OF GRADUATE STUDIES DATE _______________________________________________________________ _________________________ COLLEGE DEAN DATE _______________________________________________________________ _________________________ DEAN OF THE GRADUATE SCHOOL DATE Submit One Copy GS Form #10 (11/15) PAGE 2 OF 2 (PLEASE DO NOT ATTACH A CURRICULUM VITAE. VITAE EXCERPTS MAY BE ATTACHED FOR ITEMS BELOW) 1.
2.
3.
4.
5.
Terminal Degree __________ Year Awarded __________ Field_____________________ Institution_______________________________________________________________ Academic Rank at USA___________________________ Year of Appointment________ List Graduate courses or Upper Level (300/400) undergraduate courses taught (list name and catalogue number). List Publications or equivalent Scholarly/Creative Activities List Professional Activities (e.g. official positions or memberships on editorial boards or in professional societies, consulting and advising services, program participation, etc. If relevant information will not fit in these spaces, please attach an additional sheet as an extension of this page.