Application for the Assessment Leadership Academy

First Name: *

Last Name: *

Academic degrees earned: *

Current Position Title: *

Current Institution: *

Email: *

Office Phone: *

Cell Phone: *

Home Phone:

Mailing Address: *

Describe your higher education experience: *

Include position titles, dates, and institutions.

Describe your reasons for interest in the Academy: *

Describe your assessment experience, including assessment leadership roles: *

Describe other examples of your leadership capacity and experience: *

(e.g. participation in academic governance or serving as a department chair, faculty development director, or other administrator.)

Describe relevant areas of expertise: *

(e.g., knowledge of the assessment literature, the teaching and learning literature, national issues and controversies in higher education, statistics, research design, institutional research).

Describe your participation in relevant educational opportunities: *

(e.g., ARC workshops, WASC assessment retreats, or other assessment conferences.)

What types of institutional support will the campus provide for your participation: *

Acknowledgement of campus support and intentions for engaging the applicant : *

(Click browse and identify the file you wish to upload with your application)

Please attach a letter(.pdf or .doc) acknowledging campus support and intentions for engaging the applicant in an on-going assessment leadership role. The letter should be from an administrator at the level of Provost, Chief Academic Officer, or higher. Note: The sponsoring administrator will be cc'd on the acceptance confirmation.

Email of nominating administrator: *

Signature of the applicant: *

Please reenter your email address as an electronic signature confirming your application.

	Partial Support	Full Support	No Support
Registration fee
Travel expenses
Purchase of required readings
Release or reassigned time

Western Association of Schools and Colleges

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