APPLICATION FOR FULL INTERIM EVALUATION
FOR REAPPOINTMENT
This cover sheet will accompany the supporting materials as the packet proceeds from the
Applicant to the Provost.
NAME:
Date:
Last
First
DEPARTMENT:
CURRENT RANK:
YEARS AT EMU:
YEARS IN CURRENT RANK:
(Including this year)
(Including this year)
Pursuant to the request for submission of the application for full interim evaluation materials are
submitted for a review of:
Instructional Effectiveness
Service
EDUCATION
1.
List all degrees with date and institution; start with the most recent:
2.
Indicate number of credits earned beyond the highest degree:
Number:
3.
Discipline:
Date:
Indicate any departmentally approved equivalencies being submitted:
Equivalency:
=
EXPERIENCE
List positions held, with institution, rank/title, and date; start with most recent: