University of South Florida
College of Nursing
COURTESY FACULTY APPOINTMENT
RECOMMENDATION FORM
Directions: Complete Section 1 and 2, sign, attach the nominee’s curriculum vitae and forward to the Dean of the College of
Nursing for final determination.
SECTION 1: Nominee Information
Name: First
Middle:
Last:
State of Florida License Number:
Expiration Date:
Credentials/National Certifications:
Certifying Agency(ies):
Business/Affiliation Name:
Professional Title:
Business/Affiliation Address:
City:
Business Phone:
Personal Phone (optional):
Email Address:
Personal Email Address (optional):
State:
Zip:
SECTION 2: Recommendation
Nominee’s contributions to the College of Nursing:
Basis on which you are requesting this Courtesy Appointment:
Recommended Courtesy Level:
Instructor (1)
Assistant Prof (2)
Associate Prof (3)
Professor (4)
(1) Contributes to the teaching and/or research programs only on an occasional basis. Requires a confirmed Master’s degree
(2) Requires a confirmed doctoral degree; (MD, PhD, DNP, EdD), or an equivalent level of specialized accomplishment
(3) In addition to Assistant Professor requirements, evidence of leadership or significant contributions in nursing or related field
(4) In addition to Associate Professor requirements, evidence of distinguished achievement among one’s peers at a national and/or international level
SECTION 3: Authorizations
Recommended By (Print Name):
Signature:
Date:
Approval: Associate Dean (Print Name):
Signature:
Date:
Approval: APT Committee (required for Level 3 or 4):
Signature (Chair):
Date:
College of Nursing Dean Approval:
Signature:
Date:
Approved
Denied
Courtesy Faculty Nomination Form
V.03.2012