Administrator's Evaluation Form

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ADMINISTRATOR'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)
ADMINISTRATOR'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)
Employee's Name:
Period Covered:
PART IV - PERFORMANCE EVALUATION - PROFESSIONALISM
a. PROFESSIONAL COMPETENCE (In Items 1 through 18 below, indicate the
HIGH DEGREE
LOW DEGREE
degree of agreement with the following statements as being descriptive of the
5
4
3
2
1
rated employee performance. Any comments will be reflected in b below.)
1. Possesses capacity to acquire knowledge/grasp concepts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Represents organizational units effectively within and
2. Demonstrates appropriate knowledge and expertise in
outside the University. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
assigned tasks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Supports compliance requirements (EEO, ADA, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Motivates, challenges and develops subordinates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Develops and implements strategic planning initiatives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Performs well under physical and mental stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Accepts responsibilities willingly and accomplishes tasks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Encourages candor and frankness from subordinates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. Manages conflict. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Communicates clearly and concisely in written and oral
16. Manages resources effectively. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
format. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. Fosters cultural sensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Displays sound judgment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. Recruits and retains culturally diverse faculty and staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Seeks self-improvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Adapts to changing situations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Sets and promotes high standards
b. PROFESSIONAL ETHICS (Comment on where the rated employee is particularly outstanding or needs improvement).
Upholds University Ethical Standards.
PART V - PERFORMANCE AND POTENTIAL EVALUATION
a. Performance during this rating period. (Refer to Support Form).
[ ] Always Exceeded
[ ] Usually Exceeded
[ ] Met
[ ] Often Failed
[ ] Failed
Requirements
Requirements
Requirements
Requirements
Requirements
b. Comment on specific aspect of the performance. (Refer to Support Form and Part III of this form). Do not use
for Comments on Potential.
c. This employee's potential for higher level assignment is:
[ ] President
[ ] Vice President
[ ] Dean
[ ] Director
[ ] Administrator/Manager
[ ] Other
d. Comment on potential and improvement activities to be implemented:
e. Training/experience necessary to fulfill potential.
ADMINISTRATOR'S EVALUATION SUPPORT FORM
(For instructions, see Administrator Evaluation Reporting System Procedures Manual)
PART I - EMPLOYEE IDENTIFICATION
Name of rated employee(Last, First, MI):
College/Unit:
PART II - RATER:
RATER
Name:
Position Title:
PART III - VERIFICATION OF INITIAL FACE TO FACE DISCUSSION
An initial face to face discussion of duties, responsibilities, and performance objectives for the current rating period took place on
Employee's Initial _______
Rater's Initial _______
(Date)
PART IV - RATED EMPLOYEE COMPLETE a, b, AND c BELOW FOR THIS RATING PERIOD
a. State your significant duties and responsibilities.
Position Title is __________________________________.
Status of Task
b. List your significant contributions to last year's agreed upon goals and objectives.
Administrator's Signature and Date
Employee's Name:
Period Covered:
c. Indicate your major performance goals and objectives as agreed to for the upcoming (FY200_) year.
PART V - RATER COMMENTS (OPTIONAL)
_______________________________
Rater's Signature and Date

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