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TUSKEGEE UNIVERSITY
FACULTY RANK
NAME _____________________________________________________________________________ Last First MI ________________ __________________________________________________________ Date College and Department _______________________________________________ __________________________________ RANK CURRENTLY HELD RANK PROPOSED ______________________________ ________________________________ Date Current Rank Received Date of Employment at Tuskegee
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TO THE APPLICANT: Please submit the following documents, if applicable:
1. (__) Copy of the highest degree earned.
2. (__) Transcript(s) denoting credit hours earned beyond the highest degree.
3. (__) Reprints of copies of publications in the past five years and/or other documents to
support professional as outlined in the Faculty Handbook.
4. (__) Copies of licenses or professional certification documents.
5. (__) Copies of specialty board certification documents.
6. (__) Copies of certificates earned as a resident, intern, etc.
INSTRUCTIONS: The applicant should consult the Faculty Hankbook before completing this Promotion Blank. Follow directions carefully and type all information. Do not submit curriculum vitae, etc. in lieu of completing this Promotion Blank. It is the responsibility of the applicant to sumbmit appropriate documents and/or other supporting materials. Please sign this Promotion Blank in the space provided
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2. PROFESSIONAL DEVELOPMENT (PD)4
A. PUBLICATIONS:
(List publications during the past five years; give complete bibliographic information; submit copies, reprints or documentation of publications in press; credit is not allowed for dissertations or manuscripts not yet accepted for publication). (i) Publication of a book representing the results of research, scholarly works,
professional accomplishments or creative endeavors:
4 2)PD (i)
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(ii) Publication in an appropriate refereed journal of papers or renditions representing the results of research, scholarly works, professional accomplishments or creative activities:5
5 2)PD (ii)
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(iii) Publication in an appropriate non-refereed journal of papers or renditions representing the results of research, scholarly works, professional accomplishments or creative activities:
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(iv) Publication of at least three bulletin, pamphlets, abstracts, or the inclusion in appropriate conference proceedings of scholarly efforts, representing the results of research, professional accomplishments or creative activities:
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(v) Preparation of audiovisual tutorial computer software or similar programs which have been accepted by a refereed source:
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(vi) Documented or demonstrative evidence of professional development through outstanding and singular performance in the Arts by: a. The performance by a recognized agency of their original music, drama,
choreography, libretto or other composition of high quality, or b. The performance by the individual of music, drama, dance, or other
aesthetic renditions, or c. The creation of a painting, sculpture, architectural design, or other fine or
practical arts, and their presentations at exhibitions.
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(vii) Documented evidence of professional development through the presentation of papers or the results of scholarly activities at recognized professional meetings, seminars, symposia, workshops, etc:
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(viii) Preparation of effective instructional materials, e.g., laboratory guides, audiovisual tutorial programs, and computer assisted programs to be used by students, (standard course outlines are not acceptable in this category):
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(ix) Documented evidence of significant leadership or participation in the activities or recognized scholarly or professional organizations (membership alone is not acceptable in this category):
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(x) Documented evidence of professional development which may include strengthening the academic programs through participation in grants and contracts, research projects/grants and international programs projects/grants:
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(xi) Board certification:
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B. RESEARCH ACTIVITIES (Indicate research activities during the last five years)
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C. TEACHING SYLLABI, LABORATORY GUIDES, AUDIOVISUAL OR COMPUTER TUTORIAL PROGRAMS:
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D. PROFESSIONAL ORGANIZATION: (List and indicate participation in professional organization during the past five years; state whether member, officer, program participant, or other)
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E. OTHER FORMS OF PROFESSIONAL DEVELOPMENT:
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3. SERVICE TO THE UNIVERSITY/COMMUNITY:
A. FACULTY SPONSORSHIP OF STUDENT ACTIVITIES:
(Make concise statements)
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B. CONSULTANTSHIPS:
(To professional organizations, societies, educational institutions, industry, etc.)
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C. SERVICE ON UNIVERSITY AND OTHER COMMITTEES: (Make concise statements)
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D. INTERNATIONAL SERVICE: (Administration, institution building program, conducting research, training counterparts, etc.)
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E. COMMUNITY, STATE AND REGIONAL ACTIVITIES: (Indicate leadership in community activities, including those in state, region, etc.)
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F. OTHER SERVICES TO THE UNIVERSITY COMMUNITY, ETC: (Include those activities, etc., that do not fall into categories listed above)
What other/additional services has the applicant performed?
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4. EDUCATION (List chronologically):
A. ACADEMIC DEGREES EARNED: DEGREE EARNED SPECIALTY NAME OF INSTITUTION MONTH AND YEAR RECEIVED
(i) What is the terminal degree in your specialty? _______________________
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B. STUDIES BEYOND THE HIGHEST DEGREE EARNED: (Applicants are required to submit a transcript denoting the credit hours earned beyond the highest degree.)
NAME OF SPECIALTY CREDITS EARNED INCLUSIVE TIME IN INSTITUTION Qtr. Hrs. Sem. Hrs. DATES MONTHS
(i) Total number of quarter hours earned __________________________
(ii) Total number of semester hours earned _________________________
(iii) Date and year the highest degree was earned _____________________ (Month) (Year)
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C. PROFESSIONAL CERTIFICATION OR LICENSURE: (Applicants are required to submit a copy of licenses and/or certification document.)
NAME OF INSTITUTION SPECIALTY MONTH AND YEAR RECEIVED
D. SPECIALTY BOARD CERTIFICATION: (Applicants are required to submit a copy of certification document.)
AWARDING INSTITUTION SPECIALTY MONTH AND YEAR RECEIVED
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E. TRAINING AS RESIDENT, INTERN, NURSE-PRACTITIONER, OR OTHER NONACADEMIC POSITIONS THAT INVOLVE MEANINGFUL TRAINING IN THE APPLICANT-SPECAILTY: (Applicants are required to submit documentation)
NAME OF SPECIALTY INCLUSIVE TIME IN INSTITUTION DATES MONTHS
5. EXPERIENCE: A. ACADEMIC EXPERIENCE AT THE COLLEGE/UNIVERSITY LEVEL:
(Include experience at Tuskegee University; do not include experience gained as a graduate assistant, postdoctoral fellow, resident or intern)
NAME OF ACADEMIC ACADEMIC YEARS SUMMER SESSIONS INSTITUTION RANK HELD (Full-time Only) (Full-time Only)
B.
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C. ACADEMIC EXPERIENCE AS A GRADUATE ASSISTANT, POSTDOCTORAL FELLOW, OR AT THE PRECOLLEGE LEVEL: (Applicants are required to submit appropriate transcripts in order to receive credit for graduate assistantships.)
NAME OF ACADEMIC ACADEMIC YEARS SUMMER SESSIONS INSTITUTION RANK HELD (Full-time Only) (Full-time Only)
(i) Total years of academic experience as a graduate assistant _________
(ii) Total years of academic experience as a postdoctoral fellow_________
(iii) Total year of academic experience as the precollege level___________
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D. APPLICANTS SHOULD PROVIDE A BRIEF DESCRIPTION OF THEIR JOB RESPONSIBILITIES IN EMPLOYMENT AT TUSKEGEE UNIVERSITY: (Provide a concise description of job responsibilties since employment at Tuskegee University within the past five years.) SPECIALTY AREA AT TUSKEGEE UNIVERSITY ______________________
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FOR THE APPLICANT: I certify that facts presented herein by me are accurate and true. _________________________ _______________________________________ Date Signature of the Faculty Member
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