UNIVERSITY OF WISCONSIN-LA CROSSE

GRADUATE FACULTY MEMBERSHIP APPLICATION

Name of Applicant:                                                                                                                 

Signature of Applicant:                                                                                                           

Department:                                                                                                                           

College:                                                                                                                                  

Applying for:                Full Membership                     FORMCHECKBOX

                                    Associate Membership           FORMCHECKBOX

                                    Affiliate Membership                FORMCHECKBOX

                                    (limited term appointment)

DEPARTMENT LEVEL REVIEW

The department has reviewed the material presented by the faculty named above and the department recommends this candidate for the              membership category to the graduate faculty.

Name of Chair:                                                                                                                       

Department Chair Signature:                                                                            Date:            

DEAN’S OFFICE REVIEW

I have reviewed the material presented and endorse this candidate for the             

membership category to the graduate faculty.

Name of College Dean:                                                                                                         

College Dean Signature:                                                                       Date:                        

For use by the Office of Graduate Studies:

Application Received on ____________

Approved by the Grad Council on _______________

Please complete the following:

NOTE: If this application is for reappointment or change of status, include new or updated information since your last appointment to the graduate faculty at UW-L. 

1. Highest Earned Degree, Discipline, Institution and Year

2. Please list graduate teaching experiences including course number and title.

3. Please list your publications including titles/date of publications, journals,  bibliographic information, invited presentations, and any other scholarly activity.

4. Please list the theses, seminar papers, graduate projects or graduate comprehensive examination committees you have served on or directed. Include students name and titles of projects.

5. Please list the graduate-level internship/preceptorships (title and dates) you have supervised.

6. Please list other information that would provide evidence of your abilities to serve on the graduate faculty at UW-L.

Revised December 2007