Application for Conferment of Academic Titles

Employee Number: ………………………

Cover Sheet

APPLICATION COVER SHEET – VERSION 7

Professorship, Associate Professorship,

Readership, (please tick title applied for)

Applicant’s Details
To be completed by the applicant, Executive Dean or Director as applicable.
Full name: / Title (Mr, Mrs, Ms, Dr etc.):
Full home address including postcode: / Work phone number:
Home phone number:
Mobile:
Email address:
Current job title & faculty: / Year appointed to current post:
Proposed academic specialism to be included in title:
Professorships/ Associate Professorships/ Readerships- criteria under which the application is made. Please indicate ‘O’ for ‘outstanding achievement’ and ‘H’ for ‘very high level of achievement’,as applicable,in the professorship boxes: / Indicate ‘O’ or ‘H’ in boxes below
Category 1: Research, creative work, consultancy, professional practice or performance to the furtherance of a subject
Category 2:Learning and teaching
Category 3:Academic leadership

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Application for Conferment of Academic Titles

Employee Number: ………………………

Checklist

Application documents - checklist
(Please ensure that these exactly follow the formats stipulated in the Handbook)
Tick below
Fully completed cover sheet
Statement of application (no more than 4 sides of A4 paper)
Full, relevant, and up-to-date CV, including a full publications list
300 word Development Plan
Fully completed IPR review for the previous performance year
Full, clear and accurate details of referees (professorships only)
Clearly labelled supporting evidence appended.
Equal Opportunities Monitoring Form

Statement of Application:

***Please insert Statement of application here (no more than four pages in Ariel 11 font)***

2016/17 IPR Form

***Please copy your 2016 to 2017 IPR form here***

2017-2018 Objectives & Mid-Year review

***Please copy 2017-2018 Objectives & Mid-Year review here***

Full Academic CV

***Please insert your full academic CV here****

Development Plan:

***Please insert your Development plan here****

Supporting evidence:

***Please insert any relevant supporting evidence here****

For completion by line manager

Written statement from Head of School/Line Manager:-
Details of KPI’s to be considered with this application:
Signed: / Date:

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