PURDUE UNIVERSITY
FACULTY EXTENSION
President’s Office Form 19
Revised March, 2015
Campus: Select One
Type of Appointment: Extension/Change
Personnel No. (If Extension or Change)
Last
First
MI
Organizational Unit Name:
Position Title:
FTE:
Organizational Unit Name:
Position Title:
FTE:
Organizational Unit Name:
Position Title:
FTE:
PERIOD OF APPOINTMENT: BEGIN DATE: (month/day/year)
End Signifies:
END DATE: (month/day/year)
Select One
ANNUAL RATE OF PAY FOR THIS APPOINTMENT
$
on an
(budget year
Select One year basis
)
or
CASH RATE OF PAY FOR THIS APPOINTMENT
$
Are there any other agreements affecting the terms and conditions not covered by this document ? Select One
If “Yes”, note terms and conditions or attach documentation of these agreements and list all document(s) attached.
ATTACHMENTS/COMMENTS: 1.
2.
3.
FACULTY TENURE STATUS: (Check One)
Extension/change in Tenure status:
Explain (if applicable):
Select One (Reference Tenure date below if applicable)
Date Tenured/day following end of maximum probationary period: (month/day/year)
Are there any conditions regarding Tenure: Select One. If “Yes”, note conditions or attach documentation of these conditions.
ATTACHMENTS/: 1.
COMMENTS
2.
Except as noted above, your appointment is subject to all Purdue University policies, as they may be
amended from time to time, including but not limited to the policies specifically incorporated into your
offer letter.
AGREED:
_________________________________________
(Appointee)
(Date)
RECOMMENDED:_____________________________________________
(Vice President/Dean/Vice Chancellor/Director) (Date)
________________________________________
(Org. Unit Head)
(Date)
APPROVED:__________________________________________________
(President or Designee)
(Date)
Distribution: Original - Human Resource Services / Copy – College or School / Copy – Department / Copy – Individual