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CSU PROMOTION ONLY FORM 7/2013

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Rev. 7/2013
CALIFORNIA STATE UNIVERSITY, FRESNO
PROMOTION ONLY FORM
(WPAF Binder, Section 4)
SECTION I: GENERAL INFORMATION
Faculty Member’s Name: _________________________________________________________________
College/School: _________________________________________________________________________
Department: ___________________________________________________________________________
Application for: Promotion OR Early Promotion; Rank: Associate Professor
SECTION II: Department Peer Review Committee’s Recommendation on Promotion
After thorough review of the WPAF, and based on the criteria set in the policy on promotion, the
committee has voted and makes the following recommendation:
Promotion Recommended Promotion NOT Recommended
Number of votes for Promotion:
Number of votes for Not Promote:
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
_____________________________________________________________________________________
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
PROMOTION ONLY RECOMMENDATION FORM
PAGE
2
Faculty Member’s Name: _________________________________________________________________
SECTION III: Department Chair’s Recommendation on Promotion
Complete this section only if the Department Chair is making a separate recommendation.
The Department Chair is NOT making an independent recommendation.
After thorough review of the WPAF, and based on the requirements policy on promotion, the
department chair makes the following recommendation:
Promotion Recommended
Promotion NOT Recommended
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 RTP file 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 5:00pm on
the deadline.
_____________________________________________________________________________________
Applicant’s Signature Date
Place this form in Section 4 and place written recommendations (signed, dated and
with page numbers) in Section 5 of applicants WPAF. For Off Year Review (OYR)
faculty, send this form to the next level of review with file.
Rev. 7/2013
PROMOTION ONLY RECOMMENDATION FORM
PAGE
3
Faculty Member’s Name: _________________________________________________________________
SECTION IV: College/School Peer Review Committee’s Recommendation on Promotion
After thorough review of the WPAF, and based on the criteria set in the policy on promotion, the
committee has voted and makes the following recommendation:
Promotion Recommended
Promotion NOT Recommended
Number of votes for Promotion:
Number of votes for Not Promote:
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
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
_____________________________________________________________________________________
Committee Member’s Name (Typed) Signature Date
Rev. 7/2013
PROMOTION ONLY RECOMMENDATION FORM
PAGE
4
Faculty Member’s Name: _________________________________________________________________
SECTION V: Dean’s Recommendation on Promotion
After thorough review of the WPAF, and based on the requirements policy on promotion, the dean
makes the following recommendation:
Promotion Recommendation
Based on Department, Department Chair (if any),
College/School, & Dean recommendation:
Promotion
Recommended
Promotion
NOT
Recommended
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 RTP file 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
5:00pm on the deadline.
_____________________________________________________________________________________
Applicant’s Signature Date
Place this form in Section 4 and place written recommendations (signed, dated and with page
numbers) in Section 5 of applicants WPAF. Place newest dates on top.
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
PROMOTION ONLY RECOMMENDATION FORM
Page 1 Supplement
Faculty Member’s Name: _________________________________________________________________
ADDITIONAL SIGNATURES:
_____________________________________________________________________________________
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
_____________________________________________________________________________________
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
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CSU PROMOTION ONLY FORM 72013

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Completed 25 December 2019

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