Schrank Hall North 153, + 5002
Phone: 330-972-6511
http://www.uakron.edu/testing
Receipt Number
Office use only
Date: ___________________
Faculty Evaluation Services Request Form
Contact Information________________________________________________________________________
Department:
Last Name:
First Name:
UAnet ID:
@uakron.edu
Campus Ext:
* Note: Reports will be sent once Scantron Forms have been picked up from our office.
Evaluation Information_____________________________________________________________________
Two digit Faculty Evaluation Code:
Year of the Faculty Evaluation:
Term of the Faculty Evaluation:
1-Spring
2-Summer 5wk1
3-Summer 5wk2
4-Summer 8wk1
5-Summer Intersession
6-All Summer
7-Fall
Other: _________________________
Merge these scan sheets with previously submitted scan sheets?
2 0
If yes, please explain: _____________
________________________________________________________________________________________
Do you have online evaluation data that needs to be merged with Scantron sheet data?
Office use only_____________________________________________________________________________
Form Color:
Blue
Green
Other
Number of Forms Scanned: __________________________
File Name:
______________________________________
Date Scanned: ______________________________________
Jun 2014
Faculty Evaluation Procedure and Information Sheet
Faculty Evaluation scan sheets must be delivered to and retrieved from SHN Room 153 in person. Each
Faculty Evaluation submitted must have a current completed Faculty Evaluation Services Request Form
attached. You may refer to our web site for our hours of operation
(http://www.uakron.edu/it/instructional_services/cbae/). A ticket will be issued to you when you deliver your
Faculty Evaluation for processing. Liability issues require that this ticket be presented before we can release
your scan sheets back to you. Each Faculty Evaluation requires a signature at delivery and another when
retrieved. Liability issues also prevent us from altering scan forms in any way. Thus for best results, please
take a few minutes to ensure that all scan sheets have been properly filled in (#2 pencil only, pen will be
rejected) and are in the correct order before you check them in.
Faculty Evaluations are processed three times per year, once after the completion of the fall, spring, and
summer semesters. Do not submit your scan sheets for processing until you have collected sheets for all the
courses for the semester. Sheet order and properly completed divider sheets are critical. You will need a
unique separate divider sheet for each instructor/course/group being evaluated. All the respondent sheets
associated with that divider sheet will follow.