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									          Academic Affairs                                                               Collaborative Provision
          _________________________________________________________________________________________________


                                                                                                                                       APPENDIX 34


                                                                                                                                                        RCA
                                                         QUEEN’S UNIVERSITY BELFAST

                                                            ACADEMIC AFFAIRS OFFICE

                                                             Collaborative Provision Group

                                                        Application for Teaching Recognition

                      Section A                To be completed by the applicant in consultation with the Principal
                                               (Additional sheets of paper may be attached if necessary)

                      Section B                To be completed by the Principal

                                                                          SECTION A


Title:...........................…                 Surname:...................................                   First Names: .................................
(Prof, Dr, Mr, Mrs, Miss)


Date of Birth: ............................…………...                                  College/Institution: .................................................


Position Held: ....................................................................................................................................

Date of appointment:-                                                               To College/Institution: .............................................

                                                                                    To Present Position: ..............................................


DETAILS OF RECOGNITION SOUGHT:




PROGRAMME: .............................................................................................................................................…….

SUBJECT: .....................................................................................................................................
EITHER:                                                                 Teaching all modules in the subject                                    (please tick)

OR:                                                                           Specified Modules:                                                      (please tick)


Modules: (please list)

Name: .......................................……………………………………....                                         Module Code: ………………………………

...................................................………………………………….……                                     Module Code: ………………………………

.....................................................……………………………………..                                   Module Code: ………………………………
…………………………………………………………………………….                                                                          Module Code: ………………………………
               Academic Affairs                                                               Collaborative Provision
               _________________________________________________________________________________________________


    …………………………………………………………………………….                                                                        Module Code: ………………………………

    …………………………………………………………………………….                                                                        Module Code: ………………………………

    …………………………………………………………………………….                                                                        Module Code: ………………………………

    …………………………………………………………………………….                                                                        Module Code: ………………………………

    ...................................................……………………………………….                                   Module Code: ………………………………

    RECOGNITION ALREADY HELD

    If recognition is already held in any
    subject please give details:

    Degree programme: ..........................................................................................................................…………………..

    Subject: .........................................…            Date Awarded:....................……………          Period: …………………

    Modules: (Please list)

    Name:                                                                                               Module Code: ………………………………

    .................................................................................................   Module Code: ………………………………

    .................................................................................................   Module Code: ………………………………

    .................................................................................................   Module Code: ………………………………

    ………………………………………………………………………                                                                         Module Code: ………………………………

    ................................................................................................    Module Code: ………………………………


       ACADEMIC & PROFESSIONAL EDUCATION

       (Please give exact classification of degrees where applicable)

       Primary Degrees or Qualifications

         Institutions             Period               Full-time or                Qualifications Obtained (including   Main Subjects
         Attended                                      part-time                   classification)
s

         ……………                    …………                 ………………                      …………………………….………..                    ……………………….

         ……………                    …………                 ………………                      ………………………………………                      ……………………….

         ….…………                   …………                 ………………                      …………………………….………..                    ……………………….

         …………….                   …………                 ……………...                    …………………………….………..                    ………………………

         …………….                   …………                 ……………...                    ………………………………………                      ……………………….

       Higher Degrees or Qualifications
     Academic Affairs                                                               Collaborative Provision
     _________________________________________________________________________________________________


 Institutions Attended    Period                 Full-time or part-     Qualifications         Subjects of
                                                 time                   Obtained               Examination or title
                                                                                               of thesis


 ……………………..               …………………..              …………………                ………………….               …………………

 ……………………                 …………………..              …………………                …………………                …………………

 ……………………                 …………………..              …………………                …………………                …………………

 …………………….                …………………..              …………………..              …………………..              …………………

 …………………….                …………………..              …………………..              …………………..              …………………..

 ……………………                 …………………                …………………                …………………                …………………

TEACHING EXPERIENCE

 Institution              Position Held          Subjects               Level                  Period


 ……………………                 …………………                …………………                …………………                …………………

 ……………………                 …………………                …………………                …………………                …………………

 ……………………                 …………………                …………………                …………………                …………………

 ..……………………               …………………                …………………                …………………                …………………

 ……………………..               …………………                ………………….               …………………..              …………………..

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Application for Recognition to Supervise/Examine at MPhil/PhD Level                  (please tick)

Subject area:…………………………………………………………………………………………………

PUBLICATIONS (Use additional sheets where necessary)
    Academic Affairs                                                               Collaborative Provision
    _________________________________________________________________________________________________


THESES ALREADY SUPERVISED (Include those supervised in the last five years, using additional
sheets if necessary. If no theses supervised have been completed, please include theses currently
under supervision.)

 Student Name           Title of Thesis       Duration of            Date of               Result
                        (state degree)        Supervision            Submission

 ……………………               …………………               …………………                …………………               ………………….

 ……………………               …………………               …………………                …………………               ………………….

 ……………………               …………………               …………………                …………………               ………………….

 ……………………               …………………               …………………                …………………               ………………….


THESES ALREADY EXAMINED

 Student Name            Title of Thesis                  Date of            Result
                                                          Submission

 ……………………                ……………………………                      ………………             ………………………………..

 ……………………                ……………………………                      ………………             ………………………………..

 ……………………                ……………………………                      ………………             ………………………………..

ANY OTHER INFORMATION (e.g. consultancy, membership of relevant committees, etc.)




EVIDENCE OF CONTINUING PROFESSIONAL DEVELOPMENT FOR APPLICANTS SEEKING
RENEWAL OF RECOGNITION (e.g. qualifications, staff development courses, relevant experience,
etc. inc previous recognition granted)




Signed:                                                        Date:
    …………….…………………………(Applicant)                                …………………………………………

Signed:                                                        Date:
    ……………………………………….(Principal/Director)                       …………………………………………
Academic Affairs                                                               Collaborative Provision
_________________________________________________________________________________________________




                                QUEEN’S UNIVERSITY BELFAST

                                  ACADEMIC AFFAIRS OFFICE

                             COLLABORATIVE PROVISION GROUP

                                             SECTION B

                               PRINCIPAL/DIRECTOR’S REPORT


Name of Applicant:                        ............................................................................

Institution:                              .............................................................................

Programme and Module Subject:             ............................................................................

EITHER:                          1st time application for recognition (please tick)
  OR                             Renewal of Recognition (please tick)



TO BE COMPLETED FOR ALL APPLICANTS


1)       Please explain why the application is appropriate and why it should be supported.




TO BE COMPLETED FOR APPLICANTS SEEKING RENEWAL OF RECOGNITION ONLY


2)       Please comment on the applicant’s performance in teaching and on his/her standing in
         the subject.
Academic Affairs                                                               Collaborative Provision
_________________________________________________________________________________________________




3)          Please outline any developments which have taken place since recognition was last
            granted in relation to the continuing professional development of the applicant.




4)          Other comments:




Name of Principal/Director: ..........................................               Institution: .........................
(BLOCK CAPITALS)

Signed: ..........................................................................   Date: .................................


Please return this form to: The Secretary of the Collaborative Provision Group, Queen’s
University Belfast, Academic Affairs Office, Level 6, Administration Building, University Road,
Belfast, BT7 1NN

								
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