SUMMARY OF ACTIONS ON APPLICATION FOR FACULTY SERVICE AREA
Human Resources Action: FSA application is received and forwarded to FSA Review Officer for further review and action
___________________ ________________________________________
Date Signature of Human Resources Manager
FSA Review Officer Action: FSA application is referred to an FSA Review Committee for further review and action.
___________________ ________________________________________
Date Signature of FSA Review Officer
FSA Review Committee Action: Approved Denied
If denied, reason(s) are as follows:
Signature of Committee Members:
FSA Review Officer Faculty Member (Discipline)
Faculty Member (Discipline Faculty Member (Other)
Instructional Dean/Area Administrator Date of Action
(Upon completion, FSA Review Committee returns the form to the FSA Review Officer)
Appropriate Vice President/Director of Human Resources (or Designee) Action: FSA Approved FSA Denied
(This step is required only if the FSA application is approved by the FSA Review Committee.)
If denied, reason(s) are as follows:
Date of Action Signature of Vice President (or designee) Signature of Director of Human Resources (or designee)
FSA Review Officer - Distribution of FSA Application:
Upon completion of the FSA Application review procedure, copies of FSA applications are to be distributed as follows: Original: employee's
personnel file, Copies to: employee, and Faculty Senate Office (retained by FSA Review Officer). (Signature/Date below indicates that
distribution of copies has been completed.)
Date Completed Signature of FSA Review Officer
Human Resources Office Recording:
FSA Code Faculty Service Area Effective Date Date Entered in Personnel File
