FACULTY AFFILIATE RECOMMENDATION FORM

Middle name:
UM ID number (if known):
Mailing Address:
City: Country:
E-mail Address: Phone:
Your signature indicates that the information you have provided above is correct, and that your CV or rsum is attached.
Date:
UM Department or Program: Please complete this portion.
UM Department/Program Name:
Classification:
A: eligible to both purchase a Griz Card and obtain a NetID for access to online resources
B: eligible to purchase a Griz Card only
Department Chair or
Program Director
Date
Date
Date

Office of the Provost use: Entered in Banner by_____________________ Date_________________ (form updated November 2012)
see umt.edu/home/affiliateusers for a description of affiliate process and policy
Affiliate's CV or rsum is attached
Dean
Provost
Last name: First name:
Birth date (Month DD, YYYY):
State: Postal Code:
Affiliate Signature:
Affiliate's expected
academic
contributions to The
University of Montana
and summary of
qualifications for
appointment:
Affiliate applicant: Please complete this portion, sign and date below, and attach your CV or rsum.
UM Signatures:
Title (Ms., Mr., Dr., etc.):