Tenure Application Form Date: Name: EmplID: ______

Tenure Application Form Date: ______________ Name: ___________________________________________ BOR Breakdown of Effort: (use decimal - i.e. .60 for 60%)
EmplID: _________ 0%
Teaching/Instruction 0%
Research/Scholarship 0%
Service 0%
Patient Care/Clinical 0%
Administrative <Select Current Rank>
<Select College Tenure Track>
Current Rank: ___________________________ College Tenure Track: ____________________ <Select College or Unit>
College: ______________________________________________________________________ Primary Academic Department: ___________________________________________________ Institute/Center Membership (if applicable): ____________________________________________ Date of Hire: ______________
Date of Last Promotion: ____________ Years of Probationary Credit towards Tenure (based on initial offer letter): _____ Holds Terminal Degree:
Yes No Candidate signature affirms that the contents of this portfolio are true and correct to the best of his/her knowledge. Candidate: Committee chairs at each level, department chair, dean, provost, and president sign, mark (‘X’) approve or deny, and date: Approve Deny Date Institute/Center Director: Department P & T Committee Chair: Department Chair: Joint Appointment Dept. Chair: ________________ College P & T Committee Chair: Dean: University P & T Committee: VP A&FA: Provost: President: ______ ______ ______