office use only - middle states commission on higher … · web viewid#: middle states commission...
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Middle States Commission on Higher Education3624 Market Street, Philadelphia, PA 19104. Telephone: 267-284-5000
Evaluator Data Form[The shaded boxes will expand as you type.]
Contact Information
First Name: MI: Last Name: Suffix (Jr., III, etc.):
Salutation (Mr., Ms., Dr., Rev., etc.):
Current Job Title:
Current Institution Name:
Preferred Address (Check one): Office Home
Office Address:
Home Address:
Office Phone: Home Phone :
Fax: E-mail:
Demographic InformationThe following information is optional but helps us fulfill our institutions’ requests for teams with diverse representation:
Gender: Male Ethnicity: American Indian or Alaska Native
Your Current Institution’s Control Type: Public Appointment Year:
Languages: Retirement Year:
Office Use Only
ID#:
MSCHE Evaluator Data Form 2
Previous Professional Experience:
Please list experience prior to your current position and limit your response to those you have held in the past fifteen (15) years. You must enter at least one position, unless you click in the checkbox below.
Check here if you have worked in your current position for the past fifteen (15) years.
Job Title
Institution/Organization
City/State
Beginning & Ending Years
Job Title
Institution/Organization
City/State
Beginning & Ending Years
Job Title
Institution/Organization
City/State
Beginning & Ending Years
MSCHE Evaluator Data Form 3
Educational Credentials:
Degree:
Granting Institution:
Discipline:
Year:
Degree:
Granting Institution:
Discipline:
Year:
Degree:
Granting Institution:
Discipline:
Year:
Additional Educational or Professional Qualifications (e.g., Harvard IEM, licensures, certifications):
MSCHE Evaluator Data Form 4
Areas of ExpertisePlease identify up to five primary areas in which you feel qualified to evaluate institutions (i.e., areas of significant experience and/or expertise) plus any secondary areas of (i.e., areas with some experience and/or expertise).For each area you identify, please briefly describe your background.
Planning, Assessment, and Institutional ResearchPrimary
Secondary
Area Description of Background
Assessment of institutional effectiveness
Assessment of student learning Institutional mission Institutional (strategic) planning Institutional research
Finances, Other Resources, and Resource AllocationPrimary
Secondary
Area Description of Background
Budgeting/resource allocation Development/fund-raising Facilities specialist Finance at non-profit institutions
Finance at for-profit institutions Information technology
Governance, Leadership, and Institutional AdministrationPrimary
Secondary
Area Description of Background
Chief executive officer Faculty governance Governing boards Institutional administration Institutional policy development
Public relations
Enrollment Management, Student Support Services, and Student Development ProgramsPrimary
Secondary
Area Description of Background
Academic advisement Admissions Adult learners Career development Commuter students Counseling Developmental (pre-college) education Enrollment management Financial aid First-year experience programs
MSCHE Evaluator Data Form 5
Retention Student development and student life programs
Student support programs and services Urban populations
Academic Affairs, Faculty, and Educational and Co-curricular Offerings(Note: General education and specific academic disciplines are listed in later sections of this form.)Primary
Secondary
Area Description of Background
Academic administrator other than chief academic officer (e.g., dean, associate provost)
Alternative delivery modes (weekend, accelerated, evening, etc.) Certificate programs Chief academic officer Continuing education Credit for life experience Curriculum development Experiential learning (internships, cooperative education, etc.) Faculty teaching development First-year experience programs Graduate degree programs Honors programs Independent/self-designed academic programs Instructional technology Interdisciplinary studies Liberal studies/general studies degree programs Library Off-campus programs - domestic Off-campus programs - international Online (distance learning) programs Service learning Undergraduate degree programs Undergraduate research
General Education Curricula and CompetenciesPrimary
Secondary
Area Description of Background
General education curricula Critical analysis and reasoning
Information literacy Oral communication Quantitative reasoning Scientific reasoning Technological competence Writing
MSCHE Evaluator Data Form 6
Academic Disciplines in the Arts and HumanitiesPrimary
Secondary
Area Description of Background
Fine and performing arts, general Humanities, general Communications English English as a second language Fashion design Fine arts Foreign language (specify) Graphics/design History Music Philosophy Religion/theology Speech/oral communication (non-medical)
Theater/drama/dance Writing
Academic Disciplines in the Social SciencesPrimary
Secondary
Area Description of Background
Social/behavioral sciences, general Anthropology Economics History International studies academic programs Political science Psychology Public administration Sociology
Academic Disciplines in the Natural Sciences, Mathematics, and Computer SciencePrimary
Secondary
Area Description of Background
Natural sciences, general Biology Chemistry Computer science Environmental science Geology Mathematics Physics
MSCHE Evaluator Data Form 7
Academic Disciplines in the Health SciencesPrimary
Secondary
Area Description of Background
Health sciences, general Chiropractic Dentistry Kinesiology & physical education
Medicine Nursing Optometry Pharmacy
Other Professional/Career Academic Disciplines.Primary
Secondary
Area Description of Background
Career/occupational academic programs, general
Agriculture Architecture Business administration Criminal justice/law enforcement Engineering Family & consumer sciences Hospitality/culinary Human services, general Law Social work/social welfare Teacher education Wildlife
MSCHE Evaluator Data Form 8
Institution and Accreditation Experience
Activities Related to AccreditationPrimary
Secondary
Area Description of Background
Work with Middle States self studies Work with Middle States periodic review reports
Other institutional experience related to Middle States accreditation
Service on Middle States evaluation teams Experience with the Middle States Commission on Higher Education (Commission committees, task forces, etc.)
Experience with other regional accreditors Experience with other accreditors (e.g., specialized accreditors)
Higher education consulting
Experience, If Any, with the Following Types of InstitutionsPrimary
Secondary
Area Description of Background
Public institutions Private non-profit institutions Private for-profit institutions Two-year institutions Graduate-only institutions Health/medical institutions Theological institutions Liberal arts institutions Career preparation institutions Fine and/or performing arts institutions Historically black colleges & universities
(HBCUs)
Hispanic-serving institutions (HSIs)
MSCHE Evaluator Data Form 9
MSCHE Evaluator Data Form 10
Please list any Middle States programs that you have attended during the past three years (e.g., Annual Conference, Self Study Institute, Assessment Workshop):
Year:
Program:
Year:
Program:
Year:
Program:
Year:
Program:
Any additional relevant information (optional):