Name of nominee: Date:
Department/school:
E-mail address of nominee
Graduate courses to be taught:
Semester/term and year of approval:
Documentation of the 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:
Other education and professional experience:



Evidence of specialization in teaching area:

C. Evidence of professional activity within the last three years (workshops, research, service, creative activity, etc.). Please
put in vita format on attached sheet.
D. List the graduate courses taught by the candidate during the last three years: