ࡱ> 130Y c bjbjWW (&==c]JJJJJ VDJJ$5 L5U# UUU 2UU@TޜJJ'.SUFFOLK COUNTY COMMUNITY COLLEGE REQUEST FOR SUBSTITUTION OF PERFORMANCE/EXPERIENCE/CEU'S/UNDERGRADUATE CREDIT FOR CREDITS TOWARD PROMOTION NAME: AREA OR DIVISION: CAMPUS: DEPT. OR DISCIPLINE: PRESENT RANK: EFFECTIVE DATE: PROMOTION SOUGHT: PROSPECTIVE DATE: NOTE: ALL REQUESTS FOR SUBSTITUTION MUST BE FULLY DOCUMENTED. ATTACH ADDITIONAL SHEETS AS NEEDED. A. STATE LICENSE/PROFESSIONAL CERTIFICATION (documentation required). Specify License/Certification: Credits Requested: Documentation Attached: Yes No  B. UNDERGRADUATE HOURS Specify Courses/Credit Hours Prior approval by Vice President. Attached: Yes No C. PROFESSIONAL EXPERIENCE Brief Summary of Performance and Credits Requested Documentation from Employer Attached (e.g., dates, job responsibilities, hours per week): Yes No  D. PERFORMANCE Brief Summary of Performance and Credits Requested Administrative and PPC Evaluation and Recommendation Attached: Yes No  E. CONTINUING EDUCATION CREDITS Specify Workshops and Credits Requested Documentation Attached (e.g., description, proof of attendance, hours): Yes No  F. MAJOR PUBLICATIONS/EXEMPLARY RESEARCH CONTRIBUTIONS Specify Publications/Research and Credits Requested Documentation Attached: Yes No Applicant's Signature Date over REQUEST OF SUBSTITUTION (Continued)  Reviewed by Appropriate Dean - Signature Date Comments/Recommendation Reviewed by Appropriate Executive Dean - Signature Date  Comments/Recommendation Determination by Appropriate Vice President Chairperson of College Personnel Committee Consulted: Yes No  AREA CREDITS AWARDED License/Certification Undergraduate Hours Professional Experience  Performance  Continuing Education Credits  Major Publications/Research  Signed  Date Forward to Personnel File 3/96 "<>&(z|  * + Y [   / 0 : ; = > c jCJUmH5CJ5CJ,!"Dij} H$7$8$ |#H$7$8$ |# H$7$8$ "H$7$8$ "dhH$7$8$ ydhH$7$8$ y H$7$8$ C0* H$7$8$ 5  $H$7$8$ 5 !"Dij;<st&)9:mnz} $ % * 2 W X Y           C   / d;<st|mH$7$8$ R+S|RH$7$8$ R+S| H$7$8$ Z ZH$7$8$ Z H$7$8$ c H$7$8$ c H$7$8$ gSgH$7$8$ gS H$7$8$ t$tH$7$8$ t$ t&)9:mnwhH$7$8$ e%' H$7$8$    H$7$8$   H$7$8$ E EH$7$8$ E  H$7$8$ C 0*H$7$8$ C 0* H$7$8$ = =H$7$8$ = H$7$8$ uJguH$7$8$ uJg z} uH$7$8$  H$7$8$   H$7$8$   H$7$8$ H$7$8$ E%(0*H$7$8$ E%(0* H$7$8$ | H$7$8$ | H$7$8$ S H$7$8$ e%' $ % * 2 W X Y H$7$8$ '|! oH$7$8$ o $H$7$8$   $H$7$8$ " H$7$8$  H$7$8$  H$7$8$ H$7$8$            C H$7$8$ `H$7$8$ '|!H$7$8$ '|!  {m H$7$8$  H$7$8$ x  H$7$8$ x  H$7$8$ < H$7$8$ < H$7$8$ $X  $H$7$8$ $X  H$7$8$ .\ .H$7$8$ .\ H$7$8$ `H$7$8$ `   / 1 2 3 : < = C D c H$7$8$ 8|! H$7$8$ 2 H$7$8$ 83 8H$7$8$ 83 H$7$8$  H$7$8$  H$7$8$  / 1 2 3 : < = C D c & 00P/ =!"#$% [8@8 NormalCJ_HaJmH sH tH <A@< Default Paragraph Font^C@^ Body Text Indent'$ C0*C7$8$H$^Ca$CJc&3c$c t  c / c 8 "@ !x (  VB  C D"VB  C D"VB  C D"VB  C D"VB   C D"VB   C D"VB   C D "VB   C D "VB   C D "VB  C D"VB  C D "VB  C D "VB  C D "VB  C D "VB  C D"VB  C D"VB  C D"VB  C D"VB  C D"VB  C D"VB  C D"VB  C D "VB  C D"VB  C D"VB  C D"VB  C D"VB   C D"VB ! C D"B S  ?<=&'z{ *YZ/:=c"#"t""ttt 0 <t t "W%Wt }WWt" % t  ttt#tO)tJ)tG"I)tt#\*\t2\ \t!t>Ettttt??ta;at :=&:t!d&teyw~e Kevin Peterman#C:\My Documents\FA\SUBSTITUTION.docKevin PetermanPC:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of SUBSTITUTION.asdKevin PetermanPC:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of SUBSTITUTION.asdValued Gateway CustomerE:\substitution.docValued Gateway Customer"E:\Kevins Work\FA\substitution.doc@$c@@GTimes New Roman5Symbol3& Arial"hoRoR "'20dz SUFFOLK COUNTY COMMUNITY COLLEGEKevin PetermanValued Gateway CustomerOh+'0 0< X d p|!SUFFOLK COUNTY COMMUNITY COLLEGErosUFFKevin PetermanCevieviNormaleValued Gateway Customer2luMicrosoft Word 8.0o@@JOޜ@JOޜ՜.+,D՜.+,L hp|  L zj !SUFFOLK COUNTY COMMUNITY COLLEGE Title 6> _PID_GUIDAN{C637C4A1-08A4-11D5-8F0F-00E0291AB3EE} !"#$%&')*+,-./2Root Entry 0  F@rۜUޜ41TableC`` 8 CWordDocument(& CSummaryInformation C(  CDocumentSummaryInformation8LC<@H(CompObj 0 dCpHjObjectPool``\UޜUޜ<@+D  FMicrosoft Word Document MSWordDocWord.Document.89q