National Budget Circular No



Republic of the Philippines

Name of School

Address

Name of Faculty ______________________ College/Campus ______________

Present Rank ________________________ Department __________________

PASUC COMMON CRITERIA FOR EVALUATION OF FACULTY

NBC No. 461

SUMMARY OF POINTS

|MAJOR COMPONENTS |MAXIMUM POINTS |PREVIOUS POINTS AS OF |ADDITIONAL POINTS AS OF |TOTAL CCE POINTS |QCE POINTS |

| | |(5th Cycle) |(6th Cycle) | | |

|1.0 Educational Qualification|85 | | | | |

|2.0 Experience and Length of |25 | | | | |

|Service | | | | | |

|3.0 Professional Development,|90 | | | | |

|Achievement and Honors | | | | | |

|T O T A L |200 | | | | |

Local Evaluation Committee: UNIVERSITY Review Committee:

______________________ ______________________

Signature Over Printed Name Signature Over Printed Name

Chairman Chairman

______________________ ______________________

Signature Over Printed Name Signature Over Printed Name

Secretary Secretary

______________________ ______________________

Signature Over Printed Name Signature Over Printed Name

Member Member

Republic of the Philippines

Name of School

Address

Name of Faculty ______________________ College/Campus ______________

Present Rank ________________________ Department __________________

PASUC COMMON CRITERIA FOR EVALUATION OF FACULTY

NBC No. 461

SUMMARY OF POINTS

|MAJOR COMPONENTS |MAXIMUM POINTS |PREVIOUS POINTS AS OF |ADDITIONAL POINTS AS OF |TOTAL CCE POINTS |QCE POINTS |

| | |(5th Cycle) |(6th Cycle) | | |

|1.0 Educational Qualification|85 | | | | |

|2.0 Experience and Length of |25 | | | | |

|Service | | | | | |

|3.0 Professional Development,|90 | | | | |

|Achievement and Honors | | | | | |

|T O T A L |200 | | | | |

Local Evaluation Committee: UNIVERSITY Review Committee:

______________________ ______________________

Signature Over Printed Name Signature Over Printed Name

Chairman Chairman

______________________ ______________________

Signature Over Printed Name Signature Over Printed Name

Secretary Secretary

______________________ ______________________

Signature Over Printed Name Signature Over Printed Name

Member Member

National Budget Circular No. 461

CCE Rating Sheet

Name of University/College/School: ______________________________________________________

Name of Faculty Member: ______________________________________________________________

Present Rank: ________________________________________________________________________

|SPECIFIC FACTORS AND GUIDELINES FOR DETERMINING POINTS |Local Evaluation |Review Committee|

| | |Rating |

| | |(in permanent |

| | |green ink) |

| | |√ box for |

| | |supporting |

| | |documents |

| |Self Rating |Committee Rating| |

| |(in pencil) |(in permanent | |

| |√ box for |black ink) | |

| |supporting |√ box for | |

| |documents |supporting | |

| | |documents | |

| | | | |

|Educational Qualification ------------------------------------------------------ 85 pts. |________ |________ |________ |

| | | | |

|Highest relevant academic degree or educational attainment | | | |

| | | | |

|Supporting Document(s): | | | |

| | | | |

|Transcript of Records and/or | | | |

| | | | |

|Diploma/Certificate | | | |

| | | | |

| |________ |________ |________ |

|Doctorate 85 |________ |________ |________ |

|Master’s Degree 65 |________ |________ |________ |

|LLB, MD 65 | | | |

| | | | |

|N.B.: MD is considered a doctorate if holder is licensed and teaching in a College of Medicine. LLB is | | | |

|considered as Master’s degree if holder is a bar passer. | | | |

| | | | |

|Diploma Course (Above a Bachelor’s degree) 55 |________ |________ |________ |

|Bachelor’s Degree | | | |

| | | | |

|Four years 45 |________ |________ |________ |

|Exceeding four years 45 plus 5 |________ |________ |________ |

|for every year over 4 years | | | |

| | | | |

|N. B.: Graduates of DVM, Engineering and DDM programs are considered bachelor’s degree holders with | | | |

|additional points for years beyond 4. | | | |

| | | | |

|a. 3-year post secondary course 30 | | | |

|b. Special Courses (Non-degree) 25 | | | |

| |________ |________ |________ |

|Additional equivalent degree earned related to the present position |________ |________ |________ |

| | | | |

|Supporting Document(s) | | | |

| | | | |

|Transcript of Records and/or | | | |

| | | | |

|Diploma | | | |

| | | | |

|Approved curriculum (as needed) | | | |

| | | | |

| | | | |

|Master’s Degree 4 |________ |________ |________ |

|Bachelor’s Degree 3 |________ |________ |________ |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

| 1.3 Additional credits earned (maximum of 10 pts.) | | | |

| | | | |

|Supporting Document(s) | | | |

| | | | |

|Official class card | | | |

| | | | |

|Report of grades from the Registrar’s Office | | | |

| | | | |

| | | | |

|For every 3-unit credit earned toward | | | |

|an approved higher degree course 1 | | | |

| |________ |________ |________ |

|Experience and Length of Service --------------------------------------------- 25 pts. | | | |

| |________ |________ |________ |

|N. B.: The experience and services of a faculty designated to an administrative position like Vice President,| | | |

|Dean, Director, etc. shall be credited only once, whichever is highest, within the period of his/her | | | |

|designation. | | | |

| | | | |

|Academic experience | | | |

| | | | |

|Supporting Document(s): | | | |

| | | | |

|Service record | | | |

| | | | |

|Appointment | | | |

| | | | |

| | | | |

|For every year of full-time academic service | | | |

|in a state institution of higher learning 1.00 | | | |

| |________ |________ |________ |

|For every year of full-time academic service | | | |

|in an institution of higher learning other than SUC; | | | |

|service in a public or private research institution 0.75 | | | |

| | | | |

|Administrative experience |________ |________ |________ |

| | | | |

|Supporting Document(s) | | | |

| | | | |

|Service record | | | |

| | | | |

|Appointment and/or designation | | | |

| | | | |

|For every full-time year of administrative experience as: | | | |

| | | | |

|President 3.0 | | | |

|Vice President 2.5 |________ |________ |________ |

|Dean/Director/School Superintendent 2.0 |________ |________ |________ |

|Principal/Supervisor/Department |________ |________ |________ |

|Chairperson/Head of Unit 1.5 | | | |

| |________ |________ |________ |

|N. B.: The credit as head of unit is given to a faculty-rank holder designated to any administrative or | | | |

|supervisory position. | | | |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

| 2.3.1 For every year of relevant full-time professional and technical | | | |

|experience as: | | | |

| | | | |

|Supporting Document(s): | | | |

| | | | |

|Service record | | | |

| | | | |

|Appointment and/or designation | | | |

| | | | |

|SEC/DTI registration for entrepreneur |________ |________ |________ |

| |________ |________ |________ |

| |________ |________ |________ |

|Manager/Entrepreneur/Consultant 1.5 | | | |

|Supervisor/Head of Unit 1.0 | | | |

| | | | |

|Rank and File 0.5 |________ |________ |________ |

| |________ |________ |________ |

|For every year of experience in the public and private institution as: | | | |

|Cooperating Teacher 0.75 |________ |________ |________ |

|Basic Education Teacher 0.50 | | | |

| | | | |

|Professional Development Achievement and Honors -------------------- 90 pts. | | | |

| | | | |

|Invention, patented inventions, innovations, publications and other creative works (maximum of 30 points) | | | |

| | | | |

|For every cost and time saving innovation, | | | |

|patented invention and creative work as |________ |________ |________ |

|well as discovery of an educational, | | | |

|technical, scientific and/or cultural value 1 to 7 | | | |

| | | | |

|Sub-categories under 3.1.1 are as follows: | | | |

| | | | |

|Inventions | | | |

| | | | |

|These are original patented (or must have patent pending) works which have direct contribution to education, | | | |

|science and technology. The basis for the weight is the patent score. | | | |

| | | | |

|Supporting Document(s): | | | |

| | | | |

|Patent | | | |

| | | | |

|Certificate of patent pending | | | |

| | | | |

|Criteria Credits | | | |

| | | | |

|If patented - Multiply patent score by weight assigned according to criterion of | | | |

|utility. | | | |

| | | | |

|2. If patent pending - Multiply patent by weight accdg. to utility. | | | |

| | | | |

|N.B.: Per invention or discovery the following additional criteria and points allocations are prescribed: | | | |

|Commercial utility on: | | | |

|an international scale 7 | | | |

|a national scale 5 |________ |________ |________ |

|institutional level 2 |________ |________ |________ |

| |________ |________ |________ |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

|The accrediting bodies for these factors on the international and national scale are: | | | |

|Science and Technology – NSTA | | | |

|Education – DECS | | | |

| | | | |

|For institutional level, a University Committee shall accredit. | | | |

| | | | |

|The patent paper/document must be presented to ascertain patent score. | | | |

| | | | |

|Credit points are divided equally among two or more individuals claiming credit for the same invention. | | | |

| | | | |

|Discoveries | | | |

| | | | |

|A discovery must be the first of its kind or not of common knowledge. It shall be the result or product of | | | |

|the research of an individual or a group of faculty. | | | |

| | | | |

|Supporting Document(s) | | | |

| | | | |

|Full description of the discovery | | | |

| | | | |

|Confirmation of an international or national agency/organization/ | | | |

|association of experts | | | |

|Evidences of dissemination and utilization | | | |

| | | | |

| | | | |

|Criteria Credits | | | |

| | | | |

|Originality, educational impact, documentation 60% of 7 (.6x7) | | | |

|Evidence of wide dissemination, | | | |

|e.g. exhibits, publication 40% of 7 (.4x7) |________ |________ |________ |

| | | | |

| |________ |________ |________ |

|N.B.: Where there are more than one proponent the points are to be divided equally among them. If only one | | | |

|factor (e.g., [1] is satisfied, credit is awarded only for that factor). | | | |

|Creative work has to satisfy one or more of the following criteria: | | | |

| | | | |

|Originality 25% of 1 - 7 pts. | | | |

|Acceptability and recognition 25% of 1 - 7 pts. | | | |

|Relevance and value 25% of 1 - 7 pts. | | | |

|Documentation and evidence of dissemination 25% of 1 - 7 pts. | | | |

| |________ |________ |________ |

|Supporting Document(s) |________ |________ |________ |

| |________ |________ |________ |

|Full description of the creative work |________ |________ |________ |

| | | | |

|Evidences that shall satisfy the criteria for evaluation | | | |

| | | | |

|Appropriate certification from the duly organized committee establishing the value of the output. | | | |

| | | | |

|N. B.: The scale of 1-7 is distributed on the basis of competitiveness, thus– | | | |

|International 7 | | | |

|National 5 | | | |

|Institutional 2 | | | |

| | | | |

|Credits are divided among two or more claimants. Examples of creative works are published articles, literary| | | |

|items, musical compositions and/or arrangement, painting, sculpture, and other performing arts. |________ |________ |________ |

| |________ |________ |________ |

| |________ |________ |________ |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

| D. Research results and innovations consist of improvements / | | | |

|modifications made on existing design, process or product. | | | |

| | | | |

|Supporting Document(s): | | | |

| | | | |

|Full description of the research/creative work | | | |

| | | | |

|Evidences that shall satisfy the criteria for evaluation | | | |

| | | | |

| | | | |

|The criteria for rating and the points for each criterion are: | | | |

|Use of indigenous materials 20% of 7 pts. |________ |________ |________ |

|Relevance and value to education, 20% of 7 pts. |________ |________ |________ |

|science and technology | | | |

|Cost/time/energy/saving 20% of 7 pts. |________ |________ |________ |

|Acceptability of peers 20% of 7 pts. |________ |________ |________ |

|Dissemination/documentation 20% of 7 pts. |________ |________ |________ |

| | | | |

|For every published book: original, edited, or compiled, copyrighted/ published within the last ten years. | | | |

| | | | |

|Supporting Document(s) | | | |

|Copy of the book | | | |

| | | | |

|As original author 3 - 7 | | | |

|As co-author 2 - 5 | | | |

|As reviewer 1 - 4 | | | |

|As translator 1 - 4 |________ |________ |________ |

|As editor 1 - 3 |________ |________ |________ |

|As compiler 1 - 2 |________ |________ |________ |

| |________ |________ |________ |

|The factors and their weights are: |________ |________ |________ |

|Textbooks, including Science and Technology and References |________ |________ |________ |

| | | | |

|Role Tertiary High School Elementary | | | |

|Single author 7 pts 5 pts 4 pts | | | |

|Co-author 5 3 2 | | | |

|Reviewer 4 2 1 | | | |

|Translator 4 2 1 | | | |

|Editor 3 2 1 | | | |

|Compiler 2 1 1 |________ |________ |________ |

| |________ |________ |________ |

|For every scholarly research / monograph / educational technical articles in a technical/scientific / |________ |________ |________ |

|professional journal. |________ |________ |________ |

| |________ |________ |________ |

|Supporting Document(s) |________ |________ |________ |

|Copy of the Journal | | | |

| | | | |

|International 5 | | | |

|National 3 | | | |

|Local 2 | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| |________ |________ |________ |

| |________ |________ |________ |

| |________ |________ |________ |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

|For every instructional manual/audio-visual material | | | |

| | | | |

|Supporting Document(s) | | | |

|Copy/sample of the material | | | |

| | | | |

|Certificate of utilization | | | |

| | | | |

|Under this item are modules, laboratory manuals, operation manuals, workbooks, teaching guides, approved by | | | |

|the department or college for instructional purposes. Also included in this category are software, | | | |

|prototypes and Computer Aided Instruction materials. Submissions under this category should cover the course| | | |

|content per syllabus. | | | |

|Role Credit | | | |

|Single author or maker Full | | | |

|Co-author, co-maker Half | | | |

|For expert services, training and active participation in professional/technical activities (maximum of 30 | | | |

|pts.) | | | |

| | | | |

|Training and Seminars (maximum of 10 pts.) | | | |

| | | | |

|For every training course with a duration of at least one year (pro-rated for less than a year in accordance | | | |

|with the formula P = [(No. of Days) / 251*] x full credit and not to exceed the full credit) | | | |

| | | | |

|International 5 | | | |

|National 3 | | | |

|Local 2 | | | |

| | | | |

|* DBM Circular No. 2002-1 | | | |

|For certified relevant field training |________ |________ |________ |

|(maximum of 5 pts.) 1/120 hrs. |________ |________ |________ |

|For participation in conferences, seminars, workshops |________ |________ |________ |

| | | | |

|International 3 | | | |

|National 2 | | | |

|Local 1 | | | |

| |________ |________ |________ |

|N. B.: Very short training cannot be considered as seminar. | | | |

|Expert services rendered (maximum of 20 pts.) | | | |

| | | | |

|For serving as a short-term consultant/expert in an activity of an educational, technological, professional|________ |________ |________ |

|scientific or cultural nature (foreign or local) sponsored by the government or other agencies. |________ |________ |________ |

| |________ |________ |________ |

|Supporting Document(s) | | | |

|Memo of Agreement/Contract/Office Order pertaining to the consultancy work. | | | |

|Acknowledgement of output | | | |

| | | | |

|International 5 | | | |

|National 3 | | | |

|Local 2 | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| |________ |________ |________ |

| |________ |________ |________ |

| |________ |________ |________ |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

|For services rendered as trainer, coordinator, lecturer, resource person or guest speaker in conferences, | | | |

|workshops, and/or training courses for professionals. | | | |

| | | | |

|International 5 | | | |

|National 3 |________ |________ |________ |

|Local 2 |________ |________ |________ |

| |________ |________ |________ |

|Supporting Document(s) | | | |

|Certificate of appreciation/participation | | | |

| | | | |

|For expert services as adviser in doctoral dissertations, masteral and undergraduate thesis | | | |

|(maximum of 10 points) | | | |

| | | | |

|Doctoral dissertation 1.00 | | | |

|Masteral thesis 0.50 | | | |

|Undergraduate thesis 0.25 | | | |

| |________ |________ |________ |

|For certified services as member |________ |________ |________ |

|of the Board of Examiners in the |________ |________ |________ |

|Professional Regulations Commission | | | |

|(PRC) or in the Civil Service Commission | | | |

|(CSC) ---------------------------------------------------1 | | | |

| | | | |

|Supporting Document(s) | | | |

|Appointment or contract |________ |________ |________ |

| | | | |

|Identification card | | | |

| | | | |

|For expert services in accreditation/ | | | |

|quality assurance work as member | | | |

|of the Board of Director, Accreditor, | | | |

|member of the Technical Committee | | | |

|or Consultant Group in regional or | | | |

|national agencies. ---------------------------------- 1 | | | |

| | | | |

|For expert service as testing officer | | | |

|in trade skill certification ------------------------- 1 | | | |

| | | | |

|For services as coach/trainer of |________ |________ |________ |

|students in official activities and | | | |

|adviser of accredited student organization | | | |

|not to exceed 1 point per year ------------------- 1 |________ |________ |________ |

| | | | |

|N. B. For purposes of pro-rating a year is at least 251 days, not to exceed 12 months. | | | |

| | | | |

|Membership in professional organizations/honor societies and honors received (maximum of 10 pts.) | | | |

| | | | |

|For current individual membership in relevant professional organization(s) |________ |________ |________ |

| | | | |

|Supporting Document(s) | | | |

|Certificate of membership/Identification card/Official receipt of membership | | | |

|Copy of the official load of faculty | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

|Learned society | | | |

|Full member 2 |________ |________ |________ |

|Associate member 1 |________ |________ |________ |

|Honor society 1 |________ |________ |________ |

|Scientific society 1 |________ |________ |________ |

|Professional | | | |

|Officer 1 |________ |________ |________ |

|Member 0.5 |________ |________ |________ |

|N.B.: Learned society is an organization where the members are chosen by invitation and in recognition of | | | |

|their being considered learned in a scientific area of knowledge, e.g. National Research Council. | | | |

| | | | |

|Honor society is a society of academic scholars, e.g. Phi Delta Kappa Gamma Sigma Delta. | | | |

| | | | |

|Professional/Scientific organizations are national bodies or professional practitioners in a specific field | | | |

|or science, e.g., Philippine Inventors Society, Philippine Society for Mechanical Engineers. | | | |

| | | | |

|The PDS of the faculty shall be filed for the purposes of checking if the membership was already credited. | | | |

| | | | |

|For undergraduate academic honors earned: | | | |

| | | | |

|Summa Cum Laude ------------------------------ 5 pts | | | |

|Magna Cum Laude ------------------------------- 3 pts | | | |

|Cum Laude ---------------------------------------- 1 pt | | | |

| | | | |

|Scholarship/Fellowship. This may be degree or non-degree granting. (Credit is given only upon completion of | | | |

|the scholarship/fellowship program. Credential Needed – Certificate of Completion (Diploma) and Scholarship | | | |

|Contract/Agreement) |________ |________ |________ |

| |________ |________ |________ |

|International competitive |________ |________ |________ |

|Doctorate ---------------------------------------- 5 pts | | | |

|Masters ------------------------------------------ 4 pts | | | |

|Non-Degree ------------------------------------- 3 pts | | | |

|International, non- competitive | | | |

|Doctorate ---------------------------------------- 3 pts | | | |

|Masters ------------------------------------------ 2 pts | | | |

|Non-Degree ------------------------------------- 2 pts | | | |

|National/Regional, competitive | | | |

|Doctorate ---------------------------------------- 3 pts |________ |________ |________ |

|Masters ------------------------------------------ 2 pts |________ |________ |________ |

|Non-Degree ------------------------------------- 1 pt |________ |________ |________ |

|National/Regional, non- competitive | | | |

|Doctorate ---------------------------------------- 2 pts |________ |________ |________ |

|Masters ------------------------------------------ 1 pt |________ |________ |________ |

|Local, competitive or non-competitive --------- 1 pt |________ |________ |________ |

| | | | |

|Awards of distinction received in recognition of achievement in relevant areas of specialization/profession |________ |________ |________ |

|and/or assignment of the faculty concerned. (Credential: Plaque of Recognition, criteria for the selection |________ |________ |________ |

|and proof of competition) |________ |________ |________ |

| | | | |

|International -------------------------------------- 5 pts |________ |________ |________ |

|National/Regional ------------------------------- 3 pts |________ |________ |________ |

|Local ---------------------------------------------- 2 pts |________ |________ |________ |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| |________ |________ |________ |

| |________ |________ |________ |

| |________ |________ |________ |

Sub-Total _______ _______ _______

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Committee

|N. B.: Awards of distinction received by organizations like BSP, GSP, Red Cross, Barangay Offices, and Other | | | |

|Civic, Cultural, Religious, Community including Non-Government Organizations are classified as Community | | | |

|Outreach. | | | |

| | | | |

|The Awarding Body must be a recognized, reputable organization relevant to the field of | | | |

|specialization/assignment of the awardees. | | | |

|Community outreach (maximum of 5 pts.) | | | |

| | | | |

|For every year of participation in | | | |

|service-oriented projects in the | | | |

|community ---------------------------------------------- 1 pt | | | |

|(Activities undertaken as officer/member of any professional, social, education, or similar organizations | | | |

|shall no longer be considered.) |________ |________ |________ |

|Professional examinations | | | |

| | | | |

|For every relevant licensure and other professional examinations passed (maximum of 10 pts.) | | | |

| | | | |

|Supporting Document(s): | | | |

|Certificate of licensure | | | |

| | | | |

|Rating slip | | | |

| | | | |

|Skill certificate/Identification card | | | |

| | | | |

|Engineering, Accounting, Medicine, | | | |

|Law, Teacher’s Board, etc. ----------------------- 5 | | | |

| | | | |

|Career Executive Service Officer’s | | | |

|Examination/Career Service Executive | | | |

|Examination ---------------------------------------- 3 |________ |________ |________ |

| | | | |

|Marine Board/Seaman Certificate; Master Electrician/Master Plumber Certificate, etc.; | | | |

|Plant Mechanic Certificate; Professional | | | |

|Radio Operator Certificate ---------------------- 2 |________ |________ |________ |

| | | | |

|Other trade skill certificates --------------------- 1 | | | |

| | | | |

|N.B.: Section b is only applicable to the faculty-rank holders designated to supervisory/executive positions.| | | |

| | | | |

| |________ |________ |________ |

| | | | |

| |________ |________ |________ |

Sub-Total _________ _________ _________

Sub-total page 1 ______ page 4 ______ page 7 ______

page 2 ______ page 5 ______ page 8 ______

page 3 ______ page 6 ______ page 9 ______

Grand Total _________ _________ _________

Rank/Sub-rank ____________________________

CONFORME:

___________________ ___________________ ___________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

Faculty Member Chair, Local Evaluation Committee Chair., Univ. Review Comm.

______________________ ______________________

Signature Over Printed Name Signature Over Printed Name

Sec., Local Evaluation Committee Sec., Univ. Review Comm.

______________________ _____________________

Signature Over Printed Name Signature Over Printed Name

Member, Local Evaluation Committee Member, Univ. Review Comm.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download