FORM C: Merit Self-Assessment

(Max points = 40)

Teaching, University Citizenship & Service

Faculty Member: _________________________________
 

C1

Average SSI Scores (from calculation table)

 

 

 

 

X= Sum Means / Y = # Sections

 

 

 

1.

C1 Maximum = 10 pts

Total =

X/Y * 2

 

C2

Teaching Activities

 

 

 

 

Description

Category Code

Evidence/ Ref No.

Actual Points

1.

 

 

 

 

2.

 

 

 

 

3.

 

 

 

 

4.

 

 

 

 

5.

 

 

 

 

6.

 

 

 

 

7.

 

 

 

 

8.

 

 

 

 

9

 

 

 

 

10.

 

 

 

 

 

C2 Maximum = 15 pts

 

Sub Total

 

C3

University Citizenship/Service Activities

 

 

 

 

Description

Category Code

Evidence/ Ref No.

Actual Points

1.

 

 

 

 

2.

 

 

 

 

3.

 

 

 

 

4.

 

 

 

 

5.

 

 

 

 

6.

 

 

 

 

7.

 

 

 

 

8.

 

 

 

 

9

 

 

 

 

10.

 

 

 

 

 

C2 Maximum = 15 pts

 

Sub Total

 

 

Table C Total

 

Total Pts

 

 

___________________________________Signature and Date