Faculty member reviewed:____________________________________________________

Class and date of Observation:_________________________________________________

Peer Reviewer:_______________________________________________
 

I have received and read a copy of my peer review evaluation letter regarding the above named class observation. I request the peer review evaluation letter to be used as follows:

Please check one of the following requests:

________ a) I request that my peer review evaluation letter be placed in my personnel file and be used  to document  my teaching effectiveness, for teaching awards, merit pay increases, FAR’s, Promotion and Tenure, as per my request.
_________b) I request that my peer review evaluation letter be placed in my personnel file but only to be used upon my request.
_________c) I request not to have my peer review evaluation letter placed in my personnel file and I will take the original letter.

__________________________________________________     ______________
  Faculty Signature                                                                          Date

__________________________________________________      ______________
  DAA Signature                                                                             Date
 

Note: This form will be placed in the faculty member's personnel file.