APPLICATION FOR ADJUNCT (FACULTY OF GRADUATE STUDIES) MEMBERSHIP
MEMBERSHIP IN THE FACULTY OF GRADUATE STUDIES (FGS) IS REQUIRED FOR ALL FACULTY WHO ARE TEACHING GRADUATE COURSES, COSUPERVISING THESES, AND MEMBERS OF SUPERVISORY COMMITTEES.

ADJUNCT (FGS) MEMBERS: ARE GENERALLY NON-DALHOUSIE SCHOLARS AND MAY BE RECOMMENDED AS AN ADJUNCT (FGS) FOR TEACHING
AND/OR COMMITTEE MEMBERSHIP. AN ADJUNCT (FGS) CANNOT BE THE SOLE SUPERVISOR OF A GRADUATE STUDENT.
1. NAME OF DEPARTMENT / SCHOOL:
2. NAME OF PROPOSED MEMBER:
3. BANNER NUMBER (IF APPLICABLE):
4. REQUEST FOR ADJUNCT (FGS) APPOINTMENT
THIS REQUEST IS FOR:
3 YEARS
5 YEARS
RENEWAL
(ALL ADJUNCT (FGS) APPOINTMENTS END JUNE 30)
5. REASON FOR REQUEST (CHECK ALL THAT APPLY)
COMMITTEE M ASTER’S
CO-SUPERVISOR M ASTER’S
COMMITTEE PHD
CO-SUPERVISOR PHDS
TEACHING MASTER’S LEVEL
TEACHING PHD LEVEL
OTHER:
6. DETAILS RELATED TO BACKGROUND OF PROPOSED MEMBER
CURRENT POSITION TITLE:
EMPLOYER:
APPLICANT’S EMAIL ADDRESS:
LIST ALL ACADEMIC DEGREES:
NUMBER OF JOURNAL ARTICLES:
NUMBER OF PUBLICATIONS:
NUMBER OF CONFERENCES:
NUMBER OF OTHER:
DETAILS – RATIONALE FOR APPOINTMENT AND/OR PAST PARTICIPATION FOR RENEWAL:
7. EMPLOYER DETAILS FOR ADJUNCT (FGS) – NOTE THEY WILL BE NOTIFIED
EMPLOYER:
FULL NAME OF IMMEDIATE SUPERVISOR:
IMMEDIATE SUPERVISOR TITLE:
DR.
MS.
M R.
OTHER
IMMEDIATE SUPERVISOR EMAIL- DIRECT EMAIL ADDRESS:
Revised April 2014
Application For Faculty Of Graduate Studies Adjunct (FGS) Membership
Page 1 of 2
APPLICATION FOR ADJUNCT (FACULTY OF GRADUATE STUDIES) MEMBERSHIP
8.
APPLICANT’S DETAILS
APPLICANT’S DATE OF BIRTH:
APPLICANT’S EMAIL:
APPLICANT’S HOME ADDRESS:
APPLICANT’S HOME TELEPHONE:
9. ADDITIONAL INFORMATION
ATTACH A CURRENT CV AND ANY OTHER RELEVANT DOCUMENTS.
FOR APPLICANTS WHO CURRENTLY HOLD A BOARD APPROVED ADJUNCT (FGS) POSITION IN ANOTHER DEPARTMENT, ATTACH THE LETTER OF
APPOINTMENT THAT INCLUDES THE END DATE OF THEIR APPOINTMENT AND ATTACH A LETTER FROM THE DEPARTMENT REQUESTING ADJUNCT
(FGS) STATUS SIGNED BY THE DEPARTMENT CHAIR/HEAD/DIRECTOR.
10. DEPARTMENTAL APPROVAL
CHAIR/HEAD/DIRECTOR:
SIGNATURE:
DATE:
SIGNATURE:
DATE:
11. DEAN OF FACULTY OF GRADUATE STUDIES APPROVAL
DEAN:
12. SUBMIT TO
DEAN
FACULTY OF GRADUATE STUDIES
HENRY HICKS ACADEMIC ADMINISTRATION BUILDING, ROOM 314
DALHOUSIE UNIVERSITY
Revised April 2014
Application For Faculty Of Graduate Studies Adjunct (FGS) Membership
Page 2 of 2