Temporary Lecturer Periodic Review WPAF Checklist (Counselor)
**The following section to be filled out and signed by the faculty member under review**
Name: __________________________________________ Dept: ________________________________
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Table of Contents
Table of Contents of Appendix
UPS 210.070 (dated 6-5-14)
Vita (Updated C.V.)
Narrative Summary: Professional Counseling Performance
Copy of blank evaluation forms used for counseling, case presentation, workshops, seminars, supervision
 The documentation indicated below is REQUIRED (including all summer courses taught, if any) for the entire period of review.
If any of the required documentation is not present in the Portfolio, the faculty member must indicate why the material is missing,
or provide a reasonable equivalent.
Student
Opinion
Grade
Questionnaire
Distribution
Data
(Summaries)
(Printouts)
(Orig. Forms)
Fall
15
Summer 15
Spring 15
Fall
14
Summer 14
Spring 14
Fall
13
Summer 13
Spring 13
Raw
This section not
applicable to
Counselor Faculty.
n/a
n/a
I certify that my file is current, complete and contains all required items listed and checked off above.
Signature of faculty member submitting WPAF
Date
**The following section to be filled out and signed by the Division Chair**
 All items listed below shall be placed in the WPAF by the Division Chair at the time the WPAF is declared complete.
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Periodic Evaluation Signature Form
Copies of recommendations, evaluations and rebuttals (if any) from all levels of review, and final decisions from
all previous periods that fall under the period of review.
I have reviewed the WPAF of this faculty member against this checklist and declare it complete.
Signature of Division Chair
FAR
Revised: 3/11/2016; 02/17/2016
Date
FAR
Revised: 3/11/2016; 02/17/2016