Fillable Request-for-adjunct-faculty-appointment-2018 FM 436_ReqAdjunct 082112.indd

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Request-for-adjunct-faculty-appointment-2018 FM 436_ReqAdjunct 082112.indd

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REQUEST FOR NEW ADJUNCT FACULTY APPOINTMENT
Residential Adjunct Online Adjunct
N
ame
Last, First Middle
H
ome Address _____________________________________________________________________________________
Street, City, State Zip Code
P
hone number _______________________ Email Address _______________________
U.S. Citizen: Yes No Resident of __________________________________
State or Country
D
egrees __________________________________________ Rank _________________________________________
College or
School ______________________________________
Department ____________________ORG____________
I
n addition to degrees listed above, list credentials (certificates, etc.) that verify eligibility to teach specified subject areas:
*REQUIRED* List the discipline and courses that this app
licant will be authorized to teach (Ex: GEN 150, BLIT 120, etc.)
APPROVALS
_________
______________________________________________________________ ______________________
Department Chair Date
_________
______________________________________________________________ ______________________
Dean of Requesting College Date
_________
______________________________________________________________ ______________________
Dean of Online (necessary only for primarily online faculty) Date
_________
______________________________________________________________ ______________________
Provost Date
_________
______________________________________________________________ ______________________
President Date
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Request-for-adjunct-faculty-appointment-2018 FM 436_ReqAdjunct 082112.indd

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Completed 26 February 2020

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