DRAFT

FACULTY ACTIVITY REPORT/SELF EVALUATION

(Generated by personnel Personnel committee Committee 11-16-00, revised by the Senate Executive Committee 2-15-01)

List activities for April 1, 2001 through March 31, 2002 The annual reporting period is found in Section 7.8.1 of the Faculty Handbook. This Faculty Activity Report/Self Evaluation will cover one to five (1 to 5) years to be determined in each college by a vote of the faculty in that college.

Section I. Professional Background

Name:

Department:

Rank and date appointed to that Rank:

Office address:

Phone number:

Email:

Professional degrees and certifications (earned in past year):

Section II: Teaching

Term	Course Prefix and	Credit Hours	Course Title	Course Enroll- ments	SIE
					Total		Global Item
	Number				No. Responses	Score		No. Responses	Score
Spring
Spring
Spring
Summer
Fall
Fall
Fall

· Teaching-related grants and funding:

(For each item include: authors, title, awarding organization, date submitted, time period award, dollar value, and status (awarded, under review, rejected))

· Other instructional activities:

· Student advisement:

• Student advisees (give number)

Undergraduate:

Graduate:

• Graduate students directly supervised (give number)

Masters:

Ph.D.:

• Graduate student committees other than chair or directly supervised (give number)

Masters:

Ph.D.:

• Theses and dissertations completed under your supervision:

(For each: give student name, title of work, department, term completed, and level of degree)

Section III. Research, Creative, and Scholarly Activity

hPublications:

(Give status such as submitted, accepted. Include complete citation for each and indicate whether it was peer-reviewed.)

hPerformances, exhibitions, papers, session participation, or creative achievements:

hSponsored activities:

(Investigators (identify principal investigator), title, awarding organization, date submitted, time period of grant or contract, dollar value, status: (awarded, under review, rejected))

hProjects under preparation:

h Other activities:

Section IV: Service

hService to the institution (department, college, and university):

hService to the discipline (professional organizations and scholarly societies):

h Professional service to the public (include service grants or contracts):

hOther service activities:

Section V. Honors, Awards, and Other Forms of Special Recognition

(such as commendations that have been received in the execution of

teaching, scholarly activities, and service)

Section VI. Professional Development of the Faculty Member

(Involvement in professional meetings, professional development

program, executive development programs, extension (include any

planned activities)):

Section VII. Faculty Member's Self-Evaluation (Internal Use Only)

(Refer to the previous years’ section on "goals for the coming year" in

teaching, research and service paragraphs. Provide a

self-appraisal and explanation as well as evidence of

accomplishments and explanations for problems. The

self-assessment essay should cover teaching, research, service, and

professional activities).

Section VIII. Personal Goals for the Coming Year (Internal Use Only)

(Discuss goals in teaching, research, service, and professional development)

Section IX: Summary of time allocation (Internal Use Only)

(Estimate the allocation of your time between the three areas).

Chair’s Expected Allocation for Current Year:

Teaching ______% Research _________% Service ________%

Estimate of Actual Allocation for Current Year:

Teaching ______% Research _________% Service ________%

SECTION X: Current Faculty Curriculum Vitae (Attach copy)

TO: Dean _________________________

FROM: Department Chair _______________

RE: Annual (April 1, Year-March 31, Year+1) Performance Evaluation for [Name]

DATE: _______________

	Exceptional Performance	Acceptable Performance	Unacceptable Performance
Teaching
Research
Service
Overall

Teaching:

Research:

Service to institution, discipline and public:

Overall:

Expected time allocation: Teaching____% Research _____% Service_____%

Department Chair Signature _________________________________Date___________

Faculty Acknowledgment: I have had the opportunity to discuss this evaluation with the department chair. I understand that I have the privilege of responding in writing to this evaluation and that such response will be attached to the evaluation.

Faculty Signature: _________________________________________Date____________

Dean's Signature: __________________________________________Date___________

NOTE: This performance evaluation is one of the factors considered in determining reappointment, tenure, promotion, merit pay, and support for development, renewal, and participation in academic organizations.

Distribution: Original - Personnel file, Office of the Dean

Copy 1- Faculty Member

Copy 2 - Office of Provost and Vice President for Academic Affairs