ANNUAL PERFORMANCE REVIEW (Lab Instructor)
INFORMATION ON ACTIVITIES AND ASSESSMENT BY DEPARTMENT HEAD OR APPROPRIATE PERSON, WITH RESPECT TO:
LABORATORY INSTRUCTION AND OTHER APPROPRIATE INTRUCTIONAL DUTIES
INITIAL EVALUATION
LABORATORY DEVELOPMENT AND RELATED PROFESSIONAL ACTIVITY
INITIAL EVALUATION
September 2014
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ADMINISTRATIVE AND MAINTENANCE
INITIAL EVALUATION
PUBLIC SERVICE
INITIAL EVALUATION
September 2014
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Name:
For the Period Ending:
INITIAL REVIEWER (DEPARTMENT HEAD OR APPROPRIATE PERSON)
RECOMMENDATION RE: (COMPLETE ONLY RELEVATE SECTIONS)
1. INCREMENT
YES
NO
2. RENEW PROBATION (IF APPLICABLE)
YES
NO
N/A
3. GRANT CONTINUING APPOINTMENT (IF APPLICABLE)
YES
NO
N/A
4. MERIT INCREMENT
YES
NO
N/A
5. PROMOTION (IF APPLICABLE)
YES
NO
N/A
DATE: __________________
SIGNATURE: _________________________________
TITLE: _____________________________
FACULTY MEMBER
I HAVE READ THIS FORM (SIGNATURE DOES NOT SIGNIFY AGREEMENT WITH THE STATEMENTS)
I AM ATTACHING_____ SHEETS OF ADDITIONAL INFORMATION.
DATE: __________________
SIGNATURE OF ACADEMIC STAFF MEMBER: ____________________________________________
REVIEW COMMITTEE
RECOMMENDATION OF REVIEW COMMITTEE RE:
1. RENEW TENURE-TRACK (IF APPLICABLE)
YES
NO
N/A
2. GRANT TENURED APPOINTMENT (IF APPLICABLE)
ADDITIONAL COMMENTS/RECOMMENDATIONS:
YES
NO
N/A
DATE: __________________
SIGNATURE ON BEHALF OF REVIEW COMMITTEE: _______________________________________
RECOMMENDATION OF REVIEW COMMITTEE RE: CAREER PROGRESS
1. INCREMENT
YES
NO
2. MERIT INCREMENT
YES
NO
N/A
3. PROMOTION (IF APPLICABLE)
ADDITIONAL COMMENTS/RECOMMENDATIONS:
YES
NO
N/A
DATE: __________________
SIGNATURE ON BEHALF OF REVIEW COMMITTEE: _______________________________________
DEAN
DECISION OF DEAN RE:
1. RENEW TENURE-TRACK (IF APPLICABLE)
YES
NO
N/A
2. GRANT TENURED APPOINTMENT (IF APPLICABLE)
ADDITIONAL COMMENTS/RECOMMENDATIONS:
YES
NO
N/A
DATE: __________________
SIGNATURE: _________________________________
DECISION OF DEAN RE:
1. INCREMENT
YES
NO
2. MERIT INCREMENT
YES
NO
N/A
3. PROMOTION (IF APPLICABLE)
ADDITIONAL COMMENTS/RECOMMENDATIONS:
YES
NO
N/A
DATE: __________________
September 2014
SIGNATURE: _________________________________
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