Rev. 11/2015
CALIFORNIA STATE UNIVERSITY, FRESNO
RETENTION FORM AND APPLICATION
(WPAF Binder, Section 4 / Process separately if candidate is subject to Off-Year Review)
SECTION I: GENERAL INFORMATION
Faculty Member’s Name: _________________________________________________________________
College/School: _________________________________________________________________________
Department: ___________________________________________________________________________
Application for:
Additional Probationary Year
Current Review year is:
2
nd
3
rd
4
th
5
th
6
th
(requesting 7
th
)
SECTION II:
Department Peer Review Committee Recommendation for Additional Probationary Year (APY)
After thorough review of the WPAF, and based on the requirements in the approved probationary
plan, the committee has voted and makes the following recommendation:
Record vote on recommendation for
Additional Probationary Year
Record recommendation on
Making Normal Progress
Number of votes for Additional Probationary Year:
Yes, candidate is making normal progress.
No, candidate is not making normal progress.
Number of votes for non-retention or a Terminal
Year:
SIGNATURES:
_____________________________________________________________________________________
Review Committee Chair’s Name (Typed) Signature Date
_____________________________________________________________________________________
Department Chair’s Name (Typed) Signature (if sitting as member of committee only) Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
ADD ADDITIONAL SIGNATURE SHEETS IF NECESSARY
Print Form
Rev. 7/2013
RETENTION RECOMMENDATION FORM
PAGE
2
Faculty Member’s Name: _________________________________________________________________
SECTION III: Department Chair’s Recommendation for Additional Probationary Year
.
The Department Chair is NOT making an independent recommendation.
After thorough review of the WPAF, and based on the requirements in the approved probationary plan
the department chair makes the following recommendation:
Record recommendation for Additional
Probationary Year
Record recommendation on
Making Normal Progress
Additional Probationary Year
Non-retention or a Terminal Year:
Yes, candidate is making normal progress.
No, candidate is not making normal progress.
Signature certifies that the above recommendation and the attached written evaluation represent the
recommendation of the department chair.
_____________________________________________________________________________________
Department Chair’s Name (Typed) Signature Date
APPLICANT’S ACKNOWLEDGEMENT:
I have received a copy of this form and the attached written recommendation of the department peer
review committee and, if the department chair made a separate recommendation, a copy of the
department chair’s written recommendation as well.
I realize that signing this form does not necessarily mean that I agree with the recommendation of
the department peer review committee and/or the department chair.
I have had an opportunity to review the recommendations, and I am aware that I may submit a
response or rebuttal statement to the chair of the college/school peer review committee and the
dean. I realize that I have ten days to respond before my WPAF moves to the next level of review
and that my response or rebuttal will be incorporated into Section 6 before it moves forward. I
understand that my rebuttal MUST be submitted 10 days from the recommendation for 2
nd
, 3
rd
OYR
or Full, 5
th
OYR submit by 5pm on deadline.
_____________________________________________________________________________________
Applicant’s Signature Date
Place this form in Section 4 and place written recommendations in Section 5. Place
items in Section 4 and 5 in chronological order (oldest date on top.) For Off Year
Review (OYR) faculty, send this form to the next level of review with file.
Rev. 7/2013
RETENTION RECOMMENDATION FORM
PAGE 3
Faculty Member’s Name: _________________________________________________________________
SECTION IV:
College/School Peer Review Committee Recommendation for Additional Probationary Year
After thorough review of the WPAF, and based on the requirements in the approved probationary
plan, the committee has voted and makes the following recommendation:
Record vote on recommendation for
Additional Probationary Year
Record recommendation on
Making Normal Progress
Number of votes for Additional Probationary Year:
Yes, candidate is making normal progress.
No, candidate is not making normal progress.
Number of votes for Non-retention or a Terminal Year:
SIGNATURES:
_____________________________________________________________________________________
Review Committee Chair’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
Rev. 7/2013
RETENTION RECOMMENDATION FORM
PAGE 4
Faculty Member’s Name: _________________________________________________________________
SECTION V: Dean’s Recommendation on Additional Probationary Year
After thorough review of the WPAF, and based on the requirements in the approved probationary plan
the dean makes the following recommendation:
Record recommendation on
Additional Probationary Year
Record recommendation on
Making Normal Progress
Based on Department, Department
Chair (if any), College/School,
& Dean recommendation:
Additional Probationary Year
Non-retention or a Terminal
Year:
Yes, candidate is making
normal progress.
No, candidate is not
making normal progress.
Candidate will be reviewed by
UBRTP – at least one level had a
negative or no recommendation
Candidate will not be reviewed by
UBRTP.
Signature certifies that the above recommendation and the attached written evaluation represent the
recommendation of the dean.
_____________________________________________________________________________________
Dean’s Name (Typed) Signature Date
APPLICANT’S ACKNOWLEDGEMENT:
I have received a copy of this form, and the attached written recommendations of the
college/university peer review committee and the dean.
I realize that signing this form does not necessarily mean that I agree with the recommendation of
the college/school peer review committee and/or the dean.
I have had an opportunity to review the recommendations, and I am aware that I may submit a
response or rebuttal statement to the Chair of the University Board on Retention, Tenure, and
Promotion (UBRTP). I realize that I have ten days to respond before my WPAF moves to the next
level of review and that my response or rebuttal will be incorporated into Section 6 before it moves
forward. I understand that my rebuttal MUST be submitted 10 days from the recommendation by
5pm on the deadline.
_____________________________________________________________________________________
Applicant’s Signature Date
Place this form in Section 4 and place written recommendations in Section 5. Place
items in Section 4 and 5 in chronological order (oldest date on top.) For Off Year
Review (OYR) faculty, send this form to the next level of review with file.
SECTION VI: University Board Retention, Tenure, and Promotion’s (UBRTP) Recommendation
UBRTP’s recommendation will be mailed to the faculty member at his/her department address.
SECTION VII: Provost Decision
The Provost, acting as the President’s designee, will issue a final decision. The decision will be
available for pickup by the applicant in the Dean’s Office. Applicant signature will be required.
Rev. 7/2013
RETENTION RECOMMENDATION FORM
Page 1 Supplement
Faculty Member’s Name: _________________________________________________________________
ADDITIONAL SIGNATURES:
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date
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Committee Member’s Name (Typed) Signature Date