Evaluatee must initial and date all attachments. Rev 10/2009
SUMMARY OF RE-EVALUATION COMPONENTS
All Regular Faculty
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.
Peers
Ratings Overall
Ratings FLM/ Designee
#1 #2 #3 #4
Satisfactory Satisfactory
Needs Improvement Needs Improvement
Unsatisfactory Unsatisfactory
Summary Comments (include all evaluation components) (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
accomplished.
Has the improvement been
accomplished within established
time frame(s)?
1.
□Yes □No Explain:
2.
□Yes □No Explain:
3.
□Yes □No Explain:
4.
□Yes □No Explain:
Commendations (attach more sheets if necessary)
Recommendations (attach more sheets if necessary)
Signature of Committee Members: (Augmented reevaluation team: same members from original team and augmented by two additional regular
faculty team members. (Requires signature of the first-level manager or his/her designee.)
Peer ________________________________________________________________ ___________
Printed Name Signature Date
Peer ________________________________________________________________ ___________
Printed Name Signature Date
Peer ________________________________________________________________ ___________
Printed Name Signature Date
Peer ________________________________________________________________ ___________
Printed Name Signature Date
FLM Designee ________________________________________________________________ ___________
(if assigned) Printed Name Signature Date
FLM ________________________________________________________________ ___________
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 Eval. Self-Eval. Peer Evals. (4)
Of Attached Forms Student Summary Material from 1
st
Eval. Improv. Plan
