Prepare a self-statement which should clearly explain the justification of the Career Equity Review (CER). Supporting evidence may be provided, but is not required.

Select how you wish for the CER to be conducted out of the two options below: 

I wish to request a Career Equity Review by my Department.    

I wish to request that the Dean's Office initiate a Career Equity Review and designate a confidential ad hoc committee to provide an analysis and recommendation to me on whether to proceed with the CER. The dean will forward a redacted copy of the ad hoc committee recommendation to me and I will have 10 working days to review and choose to continue or withdraw my request for the CER.   

By signing the below, I hereby give permission to my Department and other review levels to examine all materials submitted for purposes of this Career Equity Review.  

  Faculty Signature    Date