M E M O R A N D U M
TO:
Office of the President
FROM:
(Name of Departmental Chairperson) (Name of Department)
VIA: (1
) Dean of the College
(2) Dean of the College of Graduate Studies
(3) Vice President for Academic Affairs
DATE:
RE: NOMINATION FOR APPOINTMENT TO CLINICAL MEMBERSHIP ON THE GRADUATE FACULTY
The purpose of this memorandum is to nominate for appointment
to Clinical Membership on the Graduate Faculty on the basis of the following Graduate School Policy: Full-time or part-time
faculty who holds at least a Master’s degree and professional certification in an appropriate discipline from an appropriately
accredited institution/agency/association and relevant experience in the field. This appointment is for a three-year period and may
be renewed, or a review for full membership may be requested at such time. The nominee has all the required qualifications; these are
summarized as follows:
Full Title of
Present Rank T# Number
Earned Years in Which
Degrees* Institutions Conferring Degrees* Degrees Were Earned
*
Teaching Experience (be specific)
*
Research and Other Professional Experience
*
Important Publications, Awards, and Honors
*
Evidence of Commitment to the Academic Community, The University, His or Her Students, and Academic Discipline (i.e., involvement in
university activities)*
ENDORSEMENTS:
Departmental Chairperson Date
Dean of the College Date
*A vita may be attached in lieu of any or all of this
Dean of the College of Graduate Studies Date information, provided the vita includes the required
information.
Vice President for Academic Affairs Date
After approval by all, return to College of Graduate Studies, Box 5012, Derryberry Hall Room 306.
Revised 7/2015
