President’s Office Form 36
NOMINATION FOR PROMOTION
1
DATE:
5
FULL
Last
NAME:
Proposed Rank
and Title:
Present Rank
and Title:
Previous Purdue
University
Rank(s) and
Title(s):
Penultimate Year (if applicable)
6
ACADEMIC RECORD (Institutions Attended)
2
3
4
Degree
7
First
Middle Initial
PUID
Year
Year
Year
Year
Year
Years Attended
BASIS OF NOMINATION - EMPHASIS OF SCHOLARSHIP (one or more areas may be checked)
Discovery
Learning
Engagement
8
9
PRIMARY COMMITTEE VOTES
Yes
No
Yes
No
Comments by Head of Department (or School)
Yes 
No 
Signature:
10
11
AREA COMMITTEE VOTE
Comments by Dean and/or Chancellor (for Regional Campuses)
Yes 
12
13
No 
Signature:
Yes
No
Yes
Recommended
SPACE RESERVED FOR NOTES BY MEMBERS OF UNIVERSITY COMMITTEE
UNIVERSITY COMMITTEE VOTE
Form 36 (Revised 2011)
No
Add other pages as needed; see instructions.
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