Adjunct Faculty Application

Revised 3/99

The University of West Alabama

Adjunct Faculty Application

Date
NAME / SSN / - / -
HOME ADDRESS
TELEPHONE(Home) / (Work)

Education

(Includes high school and all institutions of higher education attended.)

Institution / Major/Minor / Degree / Date Awarded

Teaching Experience

(List institutions, courses and levels, and dates.)

Institution / Course/Level / Dates

List all graduate courses taken which qualify you in the area(s) you expect to teach at The University of West Alabama:

1.  / 8. 
2.  / 9. 
3.  / 10. 
4.  / 11. 
5.  / 12. 
6.  / 13. 
7.  / 14. 

List three references:

Name / Address / Telephone #

Check all of the following arrangements under which you are willing to teach:

on campus, day courses / off campus, night courses
on campus, night courses / off campus, day and night courses
on campus, day and night courses / on and off campus, day courses
off campus, day courses / on and off campus, night courses
on and off campus, day and night courses

Department/Division Chair’s Recommendation

I recommend this candidate for adjunct status. He/she is qualified to teach the following courses:
I do not recommend this candidate for adjunct status.
(Chairperson’s signature) / (Date)

Dean’s Recommendation

I concur with the Chair’s recommendation
I concur with the Chair’s recommendation, with the following modifications:
I do not concur with the Chair’s recommendation
(Dean’s signature) / (Date)

Action by Provost

This candidate is approved for adjunct status, subject to the following conditions
This candidate is not approved for adjunct status.
(Provost’s signature) / (Date)
Official transcripts attached / yes / no

Original to Office of the Provost

cc: Division Chairperson

College Dean