_______________________________________________ ________________ ______________
_____________________________________________________________________________________________
ANCILLARY UNIT STATUS FORM
Name of Ancillary Unit: ________________________________________________________________
Director of Ancillary Unit: ________________________________________________________________
Department & College / School / Division: _________________________________________________________
New Application Renewal Application � Annual Report
Applying for Initial Approval
(See APM 110)
Status of Ancillary Unit:
Active
Enclosed
http://www.csufresno.edu/aps/apm/110.pdf
Continued Developmental Year, ___ of 3
Inactive & Applying for Renewal
Is assigned time involved for faculty in your department or program? Yes No
Name of Faculty Member Semester Assigned Number of WTUs
Assigned Time Approved X __________________________________________ ________
Assigned Time Not Approved
Signature of Department Chair / Program Coordinator Date
Assigned Time Approved X _________________________________________ _________
Assigned Time Not Approved
Signature of Dean Date
ADDITIONAL SIGNATURES:
If assigned time is given to faculty and/or staff outside the Ancillary Unit’s home department, please list the individual’s name below,
the amount of assigned time granted, and obtain the signatures of the individual’s Department Chair and Dean. Please attach
additional signatures if necessary.
Name: _____________________________________ Semester & WTUs: ____________________________
Home Dept: _________________________________ Home College/School:__________________________
Dept Chair: _________________________________ Dean: _______________________________________
X _________________________________________ X __________________________________________
Dept. Chair’s Signature & Date Dean’s Signature and Date
Centers/ Institutes cannot offer courses for university credit. Please identify all non-credit courses and any
certificates offered by the unit. A
ttach additional pages if necessary. _____________________________________________
Chair, Recommend Approval? Yes No Dean, Recommend Approval? Yes No
X _________________________________________ X __________________________________________
Dept. Chair’s Signature & Date Dean’s Signature and Date
Provost and Vice President for Academic Affairs, Recommend approval? Yes No
X _________________________________________ ____________
Provost’s Signature Date
President: Approved, 1Year Approve Continued Developmental Period Not Approved
X ________________________________________ __________
President’s Signature Date
� Other _________________
________________________
________________________
Please submit additional documentation called for in the APM 110 with this form to the Office of the Provost, M/S TA 54
