Applicant Information
Last Name First Name Middle Name or Initial
Academic Unit or School
Current Rank Year Rank Attained
Tenure Status Year Tenure Attained
Year Employed at Fairmont State University
Indicate the Academic Rank for
Which You are Applying:
Associate Professor
Assistant Professor
Indicate the name and academic rank of the colleague from your school whom you have
requested to submit a "Peer Evaluation Form" on your behalf.
Name of Colleague Rank
Applicant's Signature Date