FACULTY AFFILIATE RECOMMENDATION FORM
see umt.edu/home/affiliateusers for a description of affiliate process and policy
Affiliate applicant: Please complete this portion, sign and date below, and attach your CV or résumé.
Last name:
First name:
Birth date (Month DD, YYYY):
Middle name:
UM ID number (if known):
Mailing Address:
City:
State:
Postal Code:
E-mail Address:
Country:
Phone:
Your signature indicates that the information you have provided above is correct, and that your CV or résumé is attached.
Affiliate Signature:
Date:
UM Department or Program: Please complete this portion.
UM Department/Program Name:
Affiliate's expected
academic
contributions to The
University of Montana
and summary of
qualifications for
appointment:
Affiliate's CV or résumé is attached
Classification:
A: eligible to both purchase a Griz Card and obtain a NetID for access to online resources
B: eligible to purchase a Griz Card only
UM Signatures:
Department Chair or
Program Director
Date
Dean
Date
Provost
Date
Office of the Provost use:
Entered in Banner by_____________________ Date_________________
(form updated November 2012)