Department Head Data Narrative Form
Calendar Year 	

NAME:
RANK:
DEPARTMENT:
TENURE STATUS: (Tenured)

INSTRUCTIONS: 
1.	Faculty data reports are due by rank as follows:
a.	Assistant Professors – TBA
b.	Teaching Professors – TBA
c.	Associate Professors – TBA
d.	Full Professors – TBA
2.	Please provide the information requested below on Teaching, Scholarship, and Service. Other information shown at the bottom of page 2 will be provided to you by the middle of January.

TEACHING

Please provide a narrative description of your teaching contributions during the calendar year, including, but not limited to: course development and improvement efforts, delivery innovation efforts, funding sought and/or acquired for educational development, senior design involvement, MS and PhD committee membership (in a non-advisor role), undergraduate advising, etc.
SCHOLARSHIP

A. Publications and Presentations – please list citation information (for the calendar year):

1.	Refereed, archival journal publications 
2.	Refereed articles in conference proceedings
3.	Other Refereed publications (books, book chapters, guest editorship of special issues, etc.) 
4.	Non-refereed publications
5.	Patents and patent applications
6.	Manuscripts prepared and currently under review
7.	Invited presentations

B. Please provide a narrative discussion of your scholarship contributions during the calendar year, such as descriptions of notable achievements, unfunded projects, promising collaborations, etc. 

SERVICE

A. Departmental committees and other departmental service (e.g., assessment activities, accreditation activities, administrative activities, student group advising, special assignments, etc.) during the calendar year
B. Institutional committees and other institutional service (e.g., student group activities such as theme housing advising, faculty advisor to athletic groups, student group mentoring/advising, WISEM, SWE, participation in CASA activities, accreditation activities, partnering in other activities with Student Life, special projects)
C. External professional engagement and service during the calendar year, including, but not limited to: regional and national committees and other professional leadership, reviews and panels (indicate number of papers and proposals reviewed), editorial work for journal and book publishers, external examinations and reviews of promotion and tenure dossiers, letters of recommendation written, community and K-12 outreach, etc.
D. Mentoring and Institutional Leadership Activities
LEADERSHIP

A. Departmental
B. Institutional
C. Operations

HONORS AND AWARDS (Include only honors and awards received during the calendar year)
START-UP FUNDS

If applicable, describe how start-up funds were used during the calendar year (e.g., summer salary, graduate student support, conference travel, equipment, etc.). Include a projection of how and when remaining funds will be used.

DEPARTMENTAL GOALS AND OBJECTIVES: ASSESSMENT AND PLANS

This section should provide a brief statement of the current state-of-the-department, progress toward departmental goals and objectives defined in the previous year, and provide a statement of departmental goals and objectives for the upcoming year.
________________________________				_____________			
Faculty Member						Date

ANNUAL CERTIFICATION OF CONFLICT-OF-INTEREST AND CONFLICT-OF-COMMITMENT DISCLOSURES

I hereby certify that all conflict-of interest disclosures, consulting notifications, and external commitment notifications provided to CSM are accurate and fully reflect my activities over the past calendar year.

________________________________                                        _______
Faculty Member				        Date

THE FOLLOWING DATA WILL BE PROVIDED TO YOU

Teaching

•	Sections taught, credit hours delivered, number of students taught, student credit hours generated by course level (100 to 700), student evaluations in each course

Graduate Students

•	Number and names of PhD students graduated
•	Number and names of MS-thesis students graduated
•	Number and names of PhD students advised
•	Number and names of MS-thesis students advised
•	Names and FTE months of support of students supported on grants/contracts 

Research Funding

•	Number and list of active grants/contracts, with associated research expenditures1
•	Number and list of proposals written, with associated dollar amounts1
•	Number and list of new awards received or announced (might overlap with the list of active grants/contracts)1