Administrator'S Evaluation Form
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4ADMINISTRATOR'S EVALUATION FORM
(For instructions, see Administrator Evaluation Reporting System Procedures Manual)
PART I - ADMINISTRATIVE DATA
a. Last Name - First Name - Middle Initial:
b. SSN:
c. Present Salary:
d. Type of Appointment
[ ] Regular
[ ] Contractual
e. Unit or college of assignment (complete address):
f. Reason for Report:
[ ] Annual Salary Increment
[ ] Resignation
[ ] Termination of Employment
[ ] Retirement
[ ] Other: Record Purpose Only
g. Period Covered:
h. No. of
i. Faculty Status and Rank:
j. Faculty Tenure
[ ] Yes
From:
Thru:
Months:
Status:
(Rank)
[ ] Yes
Year/Month/Day
Year/Month/Day
[ ] No
[ ] No
k. Retreat Rights:
l. Rated Employee (Check one):
m. Employee Forwarding Address:
[ ] Yes
[ ] No
[ ] Given to Employee
Date
[ ] Forwarded to
Employee
Date
PART II - AUTHENTICATION
[ ] I approve of an annual salary increase at
a. Name of Rater (Last, First, MI):
1%; 2%; 3%; 4%; 5% of last year's salary.
[ ] No salary increment warranted.
Position Title:
Rater's Signature:
Date:
Complete Address:
b. Signature of Rated Employee:
Date:
c. Certification of Funds:
Date:
Certifying Officer:
PART III - POSITION DESCRIPTION
Position Title:
Date Hired:
Description: (Refer to Administrator's Support Form)
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Parent category: Business