has been nominated for an ancillary appointment in the host department of and the host college of .

This nomination has been approved by the candidate's home department of and the candidate's home college of .

This appointment will be effective . This is a five-year term appointment and is contingent upon a regular faculty appointment.

Attached are the candidate's curriculum vitae and a statement outlining the benefits to the candidate and the hosting department.

Approved by:

Host Department Head                                                              Date

Host College Dean                                                                     Date

Home Department Head                                                            Date

Home College Dean                                                                  Date

Provost                                                                                      Date

Candidate                                                                                  Date