Fillable Nomination Affiliate Membership - Aff Grad Fac Nom Form

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Nomination Affiliate Membership - Aff Grad Fac Nom Form

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LSU AFFILIATE GRADUATE FACULTY
NOMINATION
Submit the ORIGINAL FORM and a CURRENT VITA*
Name
Department
email address:
LSU ID
College
Nominee’s work assignment is: Teaching % Research % Administration _%
Nomination for: Research Affiliate ____Professional Affiliate
Professional Experience:
Present Rank/Title
Appointment Date
Does nominee have tenure? Yes, nominee received tenure on (Date).
No, but nominee is on tenure track.
No, nominee is not on tenure track.
Institution (also include LSU System) Rank/Title Appt Date
*Please attach a current vita, but do not use the PS-36 format.
Research or Professional Affiliate Membership requires a letter of justification specifying how the nominee will
directly benefit graduate education in the department or program.
Nominations must be made by two full members of the graduate faculty directly associated with the same
graduate degree program as the nominee. Qualifications for appointment are listed in the LSU Graduate School
Catalogue and on the LSU Graduate School Web site.
Nominated by:
Signature of Full Member #1 Date Signature of Full Member #2 Date
Typed Name Typed Name
Signature of Nominee Date Signature of Department Chair Date
Typed Name Typed Name
Signature of College Dean Date
Typed Name
Revised TGS
07/2011
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Nomination Affiliate Membership - Aff Grad Fac Nom Form

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Completed 21 June 2020

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