Evaluatee must initial and date all attachments. Rev 10/2009
All Contract
Name__________________________________________Status__________ Academic Year__________ Term _______
School/Department____________________________ Improvement Plan Written – Academic Year________ Term _______
To be used when the FLM &
peer committee agree.
To be used ONLY when the FLM & peer committee cannot reach agreement on the overall rating or there is
disagreement among the peer committee. Explanation must be provided by the FLM and peer committee as to
why agreement was not reached on an overall rating.
Ratings Overall
#1 #2 #3 CIO Designee
Satisfactory Satisfactory
Needs Improvement Needs Improvement
Unsatisfactory Unsatisfactory
Summary Comments (Evaluation will address total performance and may continue until a satisfactory level is reached or other appropriate
administrative action takes place) (attach more sheets if necessary)
Specific areas of needed
improvement in written
improvement plan.
Means of improvement
Resources available
to the evaluatee.
Timeframe within which
the improvement is to be
Has the improvement been
accomplished within established
time frame(s)?
Yes No If no, explain:
Yes No If no, explain:
Yes No If no, explain:
Yes No If no, explain:
Commendations (attach more sheets if necessary)
Recommendations (attach more sheets if necessary)
Signature of Committee Members: (Shall include the same members serving from the original Faculty Evaluation Committee.)
Peer ________________________________________________________________ ___________
Printed Name Signature Date
Peer ________________________________________________________________ ___________
Printed Name Signature Date
Peer ________________________________________________________________ ___________
Printed Name Signature Date
CIO/Designee ________________________________________________________________ ___________
(if assigned) Printed Name Signature Date
FLM/Designee ________________________________________________________________ ___________
Printed Name Signature Date
Response of Evaluatee (attach more sheets if necessary)
Signature of Evaluatee: I have reviewed the evaluation materials and have discussed their contents with the committee. (Signature does not imply
agreement with the contents of the evaluation.)
_______________________________________________ ___________
Printed Name Signature Date
Check List FLM/Designee Eval. Self-Eval. Peer Evals. (3) CIO Appointee Eval.
Of Attached Forms Student Summary Material from 1
Eval. Improv. Plan