Appendix B

Appendix B

FACULTY

QUESTIONNAIRE FOR INDIVIDUAL STAFF MEMBERS

(This information for each staff member should be gathered and submitted to the evaluating team before it proceeds to fill out the survey form for Faculty)

NAME __________________________DEPARTMENT __________________

RANK __________________________SCHOOL ______________________

A. ACADEMIC AND PROFESSIONAL PREPARATION

DegreesEducational InstitutionField of SpecializationDate

Special Training

B. EDUCATIONAL AND PROFESSIONAL TRAINING

1. Teaching Experience

DesignationInstitutionDatesNo. of Years

2. Professional Experience (other than teaching)

DesignationInstitutionDatesNo. of Years

C. WEEKLY SCHEDULE

Indicate in the table below, classes and activities regularly assigned or carried out in each period.

TimeRoomMondayTuesdayWednesdayThursdayFridaySaturday

COMMENTS

D. PROFESSIONAL ACTIVITIES

1.Membership in Professional Organizations

2.Professional Reading

List below the professional BOOKS which you have read within the last six months, and the professional PERIODICALS you regularly read.

3.In-Service Courses

Indicate courses taken during the past THREE YEARS or NOW being taken. DO NOT include courses taken BEFORE beginning to teach.

4.Indicate research activities and/or publications completed in the past five years.