NOMINATION OF CANDIDATE FOR THE PROVOST SEARCH COMMITTEE

TO:  FACULTY SENATE EXECUTIVE COMMITTEE, c/o Faculty Senate Office, 323 Stipes Hall, Macomb, IL 61455

We, the undersigned, nominate                                                             as a representative of:

(APPLICANT: CHECK ALL THAT APPLY)	(  )  The College of ______________________________

						(  )  If not elected as a college representative, I wish to be considered for at-large

						(  )  At-large only

Please Print Name				Signature					Department/School	           	           		

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I ACCEPT THE ABOVE NOMINATION FOR THE PROVOST SEARCH COMMITTEE

															
Signature of Nominee					Department/School, Academic Rank, and Years of Service at WIU

At least ten members of the eligible faculty must sign the petition.

NOTE:  Only permanent, full-time faculty may sign petitions. Department Chairs, Directors of Schools, and College Deans may not sign petition forms. If running for a college seat, only faculty from your specified college should sign your petition. 

RETURN COMPLETED PETITION TO THE OFFICE OF FACULTY SENATE, 323 STIPES HALL, NO LATER THAN 4:30 PM ON THURSDAY, AUGUST 31, 2017.