Fillable Request For Adjunct Faculty Appointment 03 2017 FM 436_ReqAdjunct 082112.indd

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Request For Adjunct Faculty Appointment 03 2017 FM 436_ReqAdjunct 082112.indd

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REQUEST FOR ADJUNCT FACULTY APPOINTMENT
Residential Adjunct Online Adjunct
Name
Last, First Middle
Home Address _____________________________________________________________________________________
Street, City, State Zip Code
Phone number _______________________ Email Address
U.S. Citizen: Yes No Resident of __________________________________
State or Country
Degrees __________________________________________ Rank _________________________________________
College or
School ______________________________________
Department ____________________ORG____________
Contract period for 1 year; 20 to 20
List credentials (degrees, certificates, etc.) that verify eligibility to teach specified subject areas:
List the discipline and courses that this applicant will be authorized to teach:
APPROVALS
_______________________________________________________________________ ______________________
Department Chair Date
_______________________________________________________________________ ______________________
Dean of Requesting College Date
_______________________________________________________________________ ______________________
Dean of Online (necessary only for primarily online faculty) Date
_______________________________________________________________________ ______________________
Provost Date
_______________________________________________________________________ ______________________
President Date
Return fully signed form to the Faculty Hiring Coordinator
FOR COMPLETION BY FACULTY RECORDS ADMINISTRATOR ONLY
Contract sent to College: __________ Contract signed by Provost: _____________________________________________
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Request For Adjunct Faculty Appointment 03 2017 FM 436_ReqAdjunct 082112.indd

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Completed 26 February 2020

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