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Department Contact: Phone: Email: Date: To: Via: Graduate Division From: Department: Re: Associate Appointment
Request for Exception to Employment Policy Form (if applicable) Eligibility Verification from Home Department Form (if applicable) UCSB Biography for Academic Personnel Form Candidate's C.V. Graduate Transcript Course Syllabus Teaching Evaluations - Include the following ESCIs and comments for:
Proposed Appointee: Academic Year: 2024-25 2025-26 Quarter(s): Fall Winter Spring Percent Time: % FTE: To be automatically calculated Annual Salary: Current Year Cost: To be automatically calculated Circumstances: How often has the course been taught by a graduate student in the past three years? List quarter and year:
Course Number and Title: Number of Units: Hours Per Week: Maximum Enrollment: Normally Taught By: Required For Major: Yes No Prerequisites: Yes No If the course satisfies a GE core area or special requirement, specify area and/or special requirement: Is this an upper division course? Yes No Is this a graduate-level course? Yes No
If yes, provide a copy of the Associate's Syllabus for the course for Committee on Courses and General Education (CCGE) or Graduate Council review.
Quarter/year first enrolled in UCSB graduate program: Overall GPA in Graduate Course Work: Number of Units Enrolled: Number of Units of incompletes/no grades: Date Masters received: Date Advanced to Candidacy:
Location: Reports To Position #:
Number of quarters as TA: Number of quarters as Associate: Total quarters of combined service in TA or Associate titles on any UC Campus: To be automatically calculated Number of Summer Session Appointments: Teaching Experience: Include a brief narrative that discusses the subject competence and relevant teaching experience of the proposed Associate:
Are any exceptions to policy (Red Binder IV-3) being requested? Yes No
Department Chair Signature
Date
Dean, Graduate Division Signature (Academic year appointments and exceptions)
Chair, CCGE or Graduate Council (upper division and graduate-level courses)
Dean, College Signature (Academic year appointments)
(Last Revised 11/2021)