PROV - Adjunct Appointment Letter Request Form

Submit as early as possible for adjunct instructor appointment.
Please find detailed instructions on form completion HERE.

1Faculty Information > 2Course 1 Assignment - CAS > 3Add'l Course Information > 4Add'l Information - CLIR > 5Review Your Entry
Academic College
Academic Department
Academic Year
Academic Term for Appointment
Faculty Name Faculty Name Title First Last Suffix
Email address

Please enter Valpo Email for existing Adjunct Faculty.

Please enter Personal Email for Adjunct Faculty new to Valpo.
New Adjunct to Valpo?

New Adjunct to Valpo? Yes No
Valpo ID # (OneCard ID)
Must be 7 characters. Currently Entered: 0 characters.
If ID is less than 7 digits, use leading zeros
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Highest degree level earned

Highest degree level earned Bachelors Master's Doctorate Juris Doctorate
Degree Earned
Upload CV

Attach Files
Degree Qualified?

Degree Qualified? Yes No

Is this person's degree at least one level higher than the level of the students they will teach and in the same or related field as the course(s) being taught?
Please upload a statement of professional qualification

Attach Files
General Assignment Information
Academic Levels to be taught

Academic Levels to be taught Undergraduate Graduate

Check all that apply
Recommended Title/Rank

Recommended Title/Rank Adjunct Instructor Adjunct Assistant Professor Adjunct Assistant Clinical Professor Adjunct Associate Professor Adjunct Associate Clinical Professor Adjunct Clinical Professor Other Other
Direct Supervisor email
Submitter email (person completing the form) if different from Direct Supervisor
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

PROV - Adjunct Appointment Letter Request Form

PROV - Adjunct Appointment Letter Request Form

General Assignment Information