Fillable Adjunct Faculty Data Request College of Health and (Bowling Green State University)

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Adjunct Faculty Data Request College of Health and (Bowling Green State University)

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Adjunct Faculty Data Request
College of Health and Human Services
Bowling Green State University
Individuals recommended for an appointment as Adjunct Faculty in the College of Health and Human
Services at Bowling Green State University are required to provide the following information.
Appointments will be for a three year period beginning July 1
st
, and will terminate on June 30th, or upon
termination of affiliation with the program. Please sign the form, attach a current resume, and return it
to the appropriate person by March 14
th
.
Name (please print)
Last First Middle
Highest Degree
Social Security Number*
Birth Date* (year/month/date)
Gender*
Agency/Institution
Agency/Institution Mailing Address
Home Mailing Address
Daytime Telephone Number
E-mail address
Adjunct faculty are eligible to receive a BGSU faculty photo identification card which would require a
BGSU email account, and a photo session on campus. Indicate your preference by checking the
appropriate box.
Yes, I want a BG1 Card--$25 due at time of photo session (which requires the establishment of
a BGSU email account if you do not already have one)
No, I do not want BG1 Card
Signature Date
*Complete only if you indicate ‘Yes, I want an ID card’.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
(must be completed by CHHS chair or director)
Please check one: New Appointment Renewed Appointment
Rank of Adjunct Faculty
CHHS Department/Program
CHHS Chair/Director Signature Date
A-D/Adjunct folder/All Other Programs Info Sheet/blj/2/11/2011
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Adjunct Faculty Data Request College of Health and (Bowling Green State University)

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Completed 17 August 2020

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