Name of nominee: Date:
Department/school:
E-mail address of nominee
Graduate course(s) to be taught:
Semester/term and year of approval:
Need for this assignment:

Length of Appointment: 1 year term: 2 year term: 3 year term:

Profile of the candidate:
A. Current position (Include academic rank if applicable):
B. Education and professional experience:
Highest degree earned: Date awarded:
Degree granting institution:
Field of specialization:

C. Evidence of other education, professional activity, and specialization in teaching area
within the last three years (workshops, research, service, creative activity, etc.). Please
put in vita format and attach.
D. List the graduate courses taught by the candidate during the last three years:

   

____________________________________________ Graduate Coordinator or Chair, Department Graduate Committee	___________________________________________ Department Chair
___________________________________________ Academic Dean	____________________________________________ Dean, Graduate School