Annual Faculty Report and Evaluation of Professional Activities

Notes on Procedure:  Section I is to be completed by the department head or chair;  the faculty member then completes Sections II-V; the alternative department or program chair fills out Section VI (if applicable); the chair of the personnel committee and the department head or chair then fill out Sections VII and VIII, respectively; the faculty member then fills out Section IX, and the department head or chair arranges for appropriate distributions.  Use additional sheets as necessary.

For the Period September 1, 2005 to August 31, 2006
(For faculty members employed at the University during any or all of this period)
I.	General Information
Name		Date		
Department		School/College		
Rank		Highest Degree and Date		
Years in Present Rank		Date of First UMass Appointment		
Tenure Decision Year				

After completing Section I the Department Head or Chair forwards form to the faculty member.

II.	Teaching Activity
A.	Instructional Activity, Credit Based
1. 	Scheduled Instruction.  List all courses, laboratories, clinics, and studio classes taught (include course number, credits, enrollments).  Please indicate if the course is interdisciplinary.
					Co-	Interdisci-
Fall/	Course	Course	No.	No.	Taught	plinary?
Spring	No.	Name	Credits	Students	(Y/N)	(Y/N)

							

							

2.	Independent Study or Practica.  List individuals who were registered for independent study or practica with you, with description of project(s).
Fall/	Course	Student	No.
Spring	No.	Name	Credits	Description

					

					

B.	Instructional Activity, Non-credit Based
List on- or off-campus non-credit workshops, training sessions or other course offerings conducted at the local, state or national level.  List name of course, location, dates, and number of participants.
			Audience:
	Course	Course	On or Off	No. Part-
Dates	Name	Location	Campus	icipants

					

					

C.	Describe any major changes in your teaching approach or responsibilities.

	
	
D.	Advising
1.	List separately departmental and interdepartmental Doctoral, Master’s, and Honors Thesis students with whom you were involved in an advisory role last year.  List name of student and major.
Role Options	Level Options	Type Options
Committee chair or major advisor	Undergraduate	Dissertation
Committee member	Master’s/CAGS	Comprehensive
Other (specify)	Doctoral	Master’s thesis
		Honors thesis
		Other (specify)
Role	Level	Type	Student	Major

					

					

2.	What were your major responsibilities in undergraduate advising and TA supervision last year?  Provide number of students for whom you were the principal advisor/supervisor.
Undergraduate		Graduate		
Departmental majors		Graduate TAs		
Interdisciplinary majors				
College majors 				
Pre-professional students (e.g. Pre-med)				
Certificate students				
Other (specify)				

E.	Instructional Materials.
List instructional materials authored including textbooks, chapters in textbooks, workbooks, computer software.  Use the following bibliographic format:  Author(s), Title, Place of publication (if applicable), year of publication.  Total pages (if applicable).
Type	Status	Refereed
Textbook	In preparation	No
Textbook chapter	Submitted	Yes
Workbook	Accepted for publication	
Lab manual	Published	
Software		
Other (specify)		
Type	Status	Refereed	Bibliographic Entry

				

				

				
				
F.	Describe any major teaching and advising activities last year which are not adequately covered in the previous sections.

	

G.	If the activities described above represent significant contributions to multiculturalism in your department, school or college, or the campus, please explain here.

	
	
III. 	Research, Creative, or Professional Activity
A.	Research Activity
1.	Scholarly Books or Chapters and Monographs: Use the following bibliographic format:  Author(s) as listed on book or monograph.  Title of Book, or Monograph, “Title of Chapter” (if applicable).  Place of publication:  Publisher, year of publication.  Total pages.
Type	Status
Book	In preparation
Chapter	Submitted
Monograph	Accepted for publication 
Other (specify)	Published
	Reprinted
	Published in translation
Type	Status	Bibliographic Entry

			

			

			

2.	Edited Books, Anthologies, Collections, Bibliographies: Use the following bibliographic format:  Editor(s) as listed on book.  Title of Book.  Place of Publication:  Publisher, year of publication.  Total pages.
Type	Status
Book	In preparation 
Anthology	Submitted
Bibliography	Accepted for publication
Collection	Published
Other (specify) 	Reprinted
	Published in translation
Type	Status	Bibliographic Entry

			

			

			

3.	Articles in Journals:  Use the following bibliographic format:  Author(s) as listed on article.  “Title of Article.”  Title of Journal.  Volume, number (if applicable), year of publication, inclusive pagination.
Type	Status
Refereed 	In preparation
Non-refereed	Submitted
Other (specify)	Accepted for publication
	Published
	Reprinted
	Published in translation
Type	Status	Bibliographic Entry

			

			

			

4.	Reviews (book, drama, music or art),  Abstracts, Pamphlets, and Other Publications:  Use the following bibliographic format:  author(s), title, pertinent publication information, and inclusive pagination (if applicable).
Type	Status
Review	In preparation
Review essay	Submitted
Abstract	Accepted for publication
Pamphlet	Published
Software	Reprinted
Technical report	Published in translation
Transcript or translation	
Patent or disclosure	
Other (specify)	
Type	Status	Bibliographic Entry

			

			

			
			
5.	Papers and presentations at off-campus conferences, meetings, symposia, etc. :  Use the following bibliographic format:  Author(s) as listed on the paper.  “Title of Paper.”  Title of Proceedings.  Place of publication:  Publisher, year of publication.  Inclusive pagination (if applicable).
Type	Status
Invited	Full Proceedings
Other (specify)	Published Abstract
	Unpublished
	Reprinted
	Published in translation
	Other (specify)
Type	Status	Bibliographic Entry

			

			

			

6.	Sponsored Activity.   List active and submitted grants and contracts.  Use the following descriptive format:  name of principal investigator(s), funding agency, period of grant and/or contract, and amount awarded or requested in direct and indirect costs.
Type	Status
Grant	Active
Contract	Awarded-not yet funded
Other (specify)	Submitted
Type	Status	Description

			

			

			
			
B.	Creative Activity:  Performances, shows, compositions, etc.
1.	Musical Works.  List musical works composed, performed, or published in your professional specialization.  If commissioned, please indicate.
Type	Status
Performance as musical conductor	In progress
Soloist in recital or concert	Completed, not yet performed, produced, or published
Ensemble participant in recital or concert	Completed and performed
Musical composition 	Performed
Musical arrangement or edition	
Other (specify)	
Type	Status	Description

			

			

			

2.	Creative writing.  List novels, drama, poetry, or other creative works.  If commissioned, please indicate.
Type	Status
Novel	In progress
Play	Completed
Poetry	Submitted
Essay	Published
Other (specify)	
Type	Status	Description

			

			

			
			
3.	Performing Arts.  List works produced, performed, or commissioned in the performing arts.  If commissioned, please indicate.
Type	Status
Leading Role, (e.g. Acting, Dance)	In progress
Supporting Role, (e.g. Acting, Dance)	Submitted
Director (theater or choreography)	Completed
Technical Design - lighting, scenic, costume 	
Other (specify)	
Type	Status	Description

			

			

			

4.	Works of Art.  List works of art produced or exhibited (painting, sculpture, exhibited works of art, etc).  If commissioned, please indicate.
Type	Status
One-person Exhibition	In progress 
Invitational Show	Completed, not yet exhibited
Juried Show	Completed and exhibited
Other (specify)	Exhibited
Type	Status	Description

			

			

			
			
C.	List other research, creative or professional activities not adequately covered in any of the previous sections.  Format:  include sufficient information to identify the activity in a complete manner.
Type	Status
Other (specify)	Completed
	Completed, not yet published, performed, or exhibited
	In progress 
Type	Status	Description

			

			

			

			

			

D.	If the activities described above represent significant contributions to multiculturalism in your department, school or college, or the campus, please explain here.

	
	
IV.	Service
A.	Campus and University
1. 	Departmental and Interdepartmental Service and Administrative Contributions.  List departmental and interdepartmental service activities.  Include sufficient information to identify the activity in a complete manner.
Type
Member of Standing or Ad Hoc Committee
Chair of Standing or Ad Hoc Committee
Administrative Position (e.g. Chair or Assoc. Chair, Graduate Program Director)
Other (specify)
Type	Description

		

		

		

		

		

2.	School, College, Campus or University Service and Administrative Contributions.  Include sufficient information to identify the activity in a complete manner.
Type
Member of standing or ad hoc committee, Faculty Senate council or committee
Chair of standing committee or ad hoc committee, Faculty Senate council or committee
Administrative position (e.g., Associate or Assistant Dean)
Officer of Faculty Senate (e.g., Speaker, Presiding Officer)
Other (specify)
Type	Description

		

		

		
		
B.	Service to Profession or Discipline
1.	Editor or ad hoc reviewer for a professional journal.   List name of journal and position held.
Position
Journal Editor
Associate Editor
Other Editorial Position (specify)
Ad Hoc Reviewer 
Position	Publication

		

		

		

2.	Member, peer review panel.  List name of panel, frequency of meeting and duration of term, if applicable.
Type	Status
Federal	Standing member
National or International	Ad hoc member
State or local	
Other (specify)	
Type	Status	Description

			

			

			
			
3.	Service to disciplinary association.  List name of organization, activity and term of office (if applicable).
Type	Status
Regional	Officer
National	Committee Member
International	Conference or Workshop Organizer
Other (specify)	Other (specify)
Type	Status	Description

			

			

			

4.	Scholarly awards, degrees and honors.  List scholarly awards, degrees and honors received.
Type	Level
Research award	Campus
Service award	Regional, state or local award
Teaching award	National
Honorary degree	International
Other award or degree (specify)	
Type	Level	Description

			

			

			
			
C.	Professional Public Service. 
List those activities involving the application of academic or professional expertise.  Include sufficient information to identify the type of service and recipient of the service in a complete manner.  List as many types as may apply to a particular activity.
Type	Recipient	
Application of research	State or local government 
Economic development	Federal government 
Clinical work	Community group
Consultation or technical assistance	Hospital or health care facility
Instruction	School, school system or educational institution
Technology transfer	Service organization
Training	Library
Other (specify)	Other non-profit
	State or local  business and industry
	National or international business and industry
	Other (specify)
Type (as many as apply)	Recipient	Description

			

			

			

D.	Other professional service activities or accomplishments not adequately covered in any of the previous sections.  Include sufficient information to identify the activity in a complete manner.

	
	
E.	If the activities described above represent significant contributions to multiculturalism in your department, school or college, or the campus, please explain here.

	
	
V.	Additional Activities
A.	Activities and accomplishments not adequately covered in any of the previous sections. Include sufficient information to identify the activity in a complete manner.

	

VI.	If the activities described in Sections II through V represent significant contributions to an interdisciplinary program or a department other than your own, the faculty member forwards this report to the appropriate program director or department head two weeks before it is due in the department office.  Otherwise, the faculty member returns form to the Department Head or Chair.
Comments of the Program Director or Department Head (Please include the basis for evaluation).

	

Signature of the Alternative Department or Program Chair
VII.	Comments of the Department Personnel Committee (Please include the basis for evaluation).

	

Signature of the Chair of Personnel Committee

VIII.	Comments of the Department Head or Chair (Please include the basis for evaluation).

	

Signature of the Department Head or Chair

After Sections VI through VIII have been completed, the Department Head or Chair returns form to the faculty member.
IX.	I certify the accuracy of Sections I through V.  In addition, I have read the comments in Sections VI through VIII.  (An additional statement, with appropriate copies, may be appended.)

			
Date		Signature of the Faculty Member	

After completing this section, the faculty member retains one photocopy and returns original to the department head or chair, who retains one photocopy and forwards original to the Dean.

Signature of the Dean

After completing this section, the Dean retains one photocopy and forwards original to the Provost.  If the Dean makes any comments, the Dean shall send a copy of this final page to the faculty member and the appropriate department head or chair when the Dean forwards the form to the Provost.