Middle States Commission on Higher Education3624 Market Street, Philadelphia, PA 19104. Telephone: 267-284-5000

Evaluator Data Form[The shaded boxes will expand as you type.]

Contact Information

First Name:       MI:       Last Name:       Suffix (Jr., III, etc.):      

Salutation (Mr., Ms., Dr., Rev., etc.):      

Current Job Title:      

Current Institution Name:      

Preferred Address (Check one): Office Home

Office Address:      

Home Address:      

Office Phone:       Home Phone :      

Fax:       E-mail:      

Demographic InformationThe following information is optional but helps us fulfill our institutions’ requests for teams with diverse representation:

Gender: Male Ethnicity: American Indian or Alaska Native

Your Current Institution’s Control Type: Public Appointment Year:      

Languages:       Retirement Year:      

Office Use Only

ID#:     

MSCHE Evaluator Data Form 2

Previous Professional Experience:

Please list experience prior to your current position and limit your response to those you have held in the past fifteen (15) years. You must enter at least one position, unless you click in the checkbox below.

Check here if you have worked in your current position for the past fifteen (15) years.

Job Title      

Institution/Organization      

City/State      

Beginning & Ending Years      

Job Title      

Institution/Organization      

City/State      

Beginning & Ending Years      

Job Title      

Institution/Organization      

City/State      

Beginning & Ending Years      

MSCHE Evaluator Data Form 3

Educational Credentials:

Degree:      

Granting Institution:      

Discipline:      

Year:      

Degree:      

Granting Institution:      

Discipline:      

Year:      

Degree:      

Granting Institution:      

Discipline:      

Year:      

Additional Educational or Professional Qualifications (e.g., Harvard IEM, licensures, certifications):     

MSCHE Evaluator Data Form 4

Areas of ExpertisePlease identify up to five primary areas in which you feel qualified to evaluate institutions (i.e., areas of significant experience and/or expertise) plus any secondary areas of (i.e., areas with some experience and/or expertise).For each area you identify, please briefly describe your background.

Planning, Assessment, and Institutional ResearchPrimary

Secondary

Area Description of Background

Assessment of institutional effectiveness

     

Assessment of student learning      Institutional mission      Institutional (strategic) planning      Institutional research      

Finances, Other Resources, and Resource AllocationPrimary

Secondary

Area Description of Background

Budgeting/resource allocation      Development/fund-raising      Facilities specialist      Finance at non-profit institutions

     

Finance at for-profit institutions      Information technology      

Governance, Leadership, and Institutional AdministrationPrimary

Secondary

Area Description of Background

Chief executive officer      Faculty governance      Governing boards      Institutional administration      Institutional policy development

     

Public relations      

Enrollment Management, Student Support Services, and Student Development ProgramsPrimary

Secondary

Area Description of Background

Academic advisement      Admissions      Adult learners      Career development      Commuter students      Counseling      Developmental (pre-college) education      Enrollment management      Financial aid      First-year experience programs      

MSCHE Evaluator Data Form 5

Retention      Student development and student life programs

     

Student support programs and services      Urban populations      

Academic Affairs, Faculty, and Educational and Co-curricular Offerings(Note: General education and specific academic disciplines are listed in later sections of this form.)Primary

Secondary

Area Description of Background

Academic administrator other than chief academic officer (e.g., dean, associate provost)

     

Alternative delivery modes (weekend, accelerated, evening, etc.)      Certificate programs      Chief academic officer      Continuing education      Credit for life experience      Curriculum development      Experiential learning (internships, cooperative education, etc.)      Faculty teaching development      First-year experience programs      Graduate degree programs      Honors programs      Independent/self-designed academic programs      Instructional technology      Interdisciplinary studies      Liberal studies/general studies degree programs      Library      Off-campus programs - domestic      Off-campus programs - international      Online (distance learning) programs      Service learning      Undergraduate degree programs      Undergraduate research      

General Education Curricula and CompetenciesPrimary

Secondary

Area Description of Background

General education curricula      Critical analysis and reasoning

     

Information literacy      Oral communication      Quantitative reasoning      Scientific reasoning      Technological competence      Writing      

MSCHE Evaluator Data Form 6

Academic Disciplines in the Arts and HumanitiesPrimary

Secondary

Area Description of Background

Fine and performing arts, general      Humanities, general      Communications      English      English as a second language      Fashion design      Fine arts      Foreign language (specify)      Graphics/design      History      Music      Philosophy      Religion/theology      Speech/oral communication (non-medical)

     

Theater/drama/dance      Writing      

Academic Disciplines in the Social SciencesPrimary

Secondary

Area Description of Background

Social/behavioral sciences, general      Anthropology      Economics      History      International studies academic programs      Political science      Psychology      Public administration      Sociology      

Academic Disciplines in the Natural Sciences, Mathematics, and Computer SciencePrimary

Secondary

Area Description of Background

Natural sciences, general      Biology      Chemistry      Computer science      Environmental science      Geology      Mathematics      Physics      

MSCHE Evaluator Data Form 7

Academic Disciplines in the Health SciencesPrimary

Secondary

Area Description of Background

Health sciences, general      Chiropractic      Dentistry      Kinesiology & physical education

     

Medicine      Nursing      Optometry      Pharmacy      

Other Professional/Career Academic Disciplines.Primary

Secondary

Area Description of Background

Career/occupational academic programs, general

     

Agriculture      Architecture      Business administration      Criminal justice/law enforcement      Engineering      Family & consumer sciences      Hospitality/culinary      Human services, general      Law      Social work/social welfare      Teacher education      Wildlife      

MSCHE Evaluator Data Form 8

Institution and Accreditation Experience

Activities Related to AccreditationPrimary

Secondary

Area Description of Background

Work with Middle States self studies      Work with Middle States periodic review reports

     

Other institutional experience related to Middle States accreditation

     

Service on Middle States evaluation teams      Experience with the Middle States Commission on Higher Education (Commission committees, task forces, etc.)

     

Experience with other regional accreditors      Experience with other accreditors (e.g., specialized accreditors)

     

Higher education consulting      

Experience, If Any, with the Following Types of InstitutionsPrimary

Secondary

Area Description of Background

Public institutions       Private non-profit institutions       Private for-profit institutions       Two-year institutions       Graduate-only institutions       Health/medical institutions       Theological institutions       Liberal arts institutions       Career preparation institutions       Fine and/or performing arts institutions       Historically black colleges & universities

(HBCUs)     

Hispanic-serving institutions (HSIs)      

MSCHE Evaluator Data Form 9

MSCHE Evaluator Data Form 10

Please list any Middle States programs that you have attended during the past three years (e.g., Annual Conference, Self Study Institute, Assessment Workshop):

Year:      

Program:      

Year:      

Program:      

Year:      

Program:      

Year:      

Program:      

Any additional relevant information (optional):