Pre-Six Lecturer Assessment/Reappointment Form

UCSC:APO rev 12/08

For reappointment to all other pre-six Unit 18 titles, use the Document Inventory for Pre-Six Reappointment (instructions)
Also use for Educator without Salary title

Candidate Material to the Department:
Date To Division:

Department/Unit Completes

Name:	Division:	Dept/Unit:
Within recommending dept/unit - Current or most recent Annual Salary Rate: $	Quarters of service to date:

Proposed Reappointment

Recruitment Compliance: Search # Compliance dated: or Waiver dated:

Proposed annual salary rate: $ Proposed % time Proposed actual salary: $

Proposed period of appointment (maximum Pre-6 reappointment term is 3 academic years)

Proposed assignments: List courses and/or equivalencies with corresponding IWCs, and designate nature of appointment

Fall
Winter
Spring

Assessment of the Candidate

Review Period:

List courses for which student evaluations were considered and/or note with an asterisk (*) on CV
This box has a limit of 3 lines

OR There are currently no student evaluations for the review period available for assessment

	Teaching ability and/or performance of other assigned duties has been assessed and meets competency standard
	The Candidate submitted OPTIONAL material that was considered in this assessment (e.g., response to this assessment, instructional materials, statement of pedagogical philosophy and goals, unsolicited letters, etc.)
	The Candidate’s address for correspondence: This box has a limit of 3 lines

X______________________________________________________ ______________
Signature of Department Chair/Unit Head verifies the assessment Date

Prior and/or Concurrent UC Employment: Yes No If YES, provide title, location, and dates:
This box has a limit of 3 lines

ASSESSMENT FILE RETAINED BY DEPARTMENT/UNIT: copies of assessment form, CV, checklist, and letter of justification (if any); and original student evaluations, and optional materials (if any)
FORWARD TO DIVISION: original assessment form, checklist, CV, and letter of justification (if any)

Division Completes

Annual Salary Rate:

Note step increase and reason, if applicable:

Appt. Basis: 9/9 month 9/12 month %Time: Actual Salary: $

Pay Dates Service Dates

Is 9/12 basis the result of averaging due to assignments outside the recommending department/program/unit?:
Yes or No

If yes, note other department assignments and service dates:
This box has a limit of 3 lines