Emeritus Status Approval Form

Emeritus Status Approval Form
In accordance with Academic Personnel Manual 120, Emerita/Emeritus Titles, Chancellor's approval is needed to confer the title of emeritus to Academic Senate members in the following series: Lecturer with Security of Employment, Professor of Clinical X, and Professor In Residence.
Name*
Last, First Middle
Title at Time of Retirement*
Retirement Date*

MonthDayYear
Department*
School
ACKNOWLEDGEMENT AND SIGNATURE

Please "Print to PDF", then click edit PDF to sign.
Department Chair's Signature
Print Name
Date

MonthDayYear
Dean's Signature
Print Name
Date

MonthDayYear
Vice Provost's Signature
Print Name
Date

MonthDayYear
Provost and Executive Vice Chancellor's Signature
Print Name
Date

MonthDayYear
APPROVAL
I approve and confer the title of emerita/emeritus to Name of Faculty.
Chancellor's Signature
Print Name
Date

MonthDayYear
Updated 8/25
Should be Empty: