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Summary: Senior Vice President forAcademic Affairs
Recommendation for Faculty Appointment
Name Social Security Number
Date of Birth Place of Birth Race Sex
Citizen of If naturalized, give date, place,
what Country and naturalization certificate no.
Conversant in English (Y) (N) Relatives employed by UGA (Y) (N) (See Section 802.3 in Regents Policies)
School/College (or unit) Department
Number years prior
Rank/Title credit toward tenure
Salary rate recommended Term of appointment* Effective Date
% Instruction % Administration % Research % Public Service
% State % Sponsored
If part-time amount If temporary period
of EFT or Course amount $ of appointment
COLLEGIATEAND PROFESSIONALEDUCATION
Degree Institution Date(mm/dd/yyyy) Major Field Minor Field
**
** Degree Certification attached for highest degree listed (Y) (N)
WORK BEYOND LAST EARNED DEGREE
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