Fillable Request-for-adjunct-faculty-appointment-2017 FM 436_ReqAdjunct 082112.indd

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Request-for-adjunct-faculty-appointment-2017 FM 436_ReqAdjunct 082112.indd

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REQUEST FOR NEW 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____________
In addition to degrees listed above, list credentials (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
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Request-for-adjunct-faculty-appointment-2017 FM 436_ReqAdjunct 082112.indd

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Completed 26 February 2020

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