UNIVERSITY OF ILLINOIS AT CHICAGO



CLINICAL DISCIPLINE NON-TENURE TRACKPROMOTION FORMS – ACADEMIC YEAR 2020-21*CANDIDATE’S PERSONNEL & APPOINTMENT INFORMATION MUST BE ENTERED AS LISTED IN BANNER/HR FRONT END*Candidate: Last Name, First Name & Middle (if applicable) UIN #: UIN #College: Select College for Primary Appointment Department: Unit Name%FTE: %FTE %Joint Appointment College: Select Joint College (if applicable) Select Joint Unit Type: Joint Unit Name%FTE: %FTE%Courtesy Appt. (0%FTE/UNPAID): Select Courtesy Appt. CollegeSelect Unit Type: Unit Name(s)Present Personnel Appointment:Rank: Select RankJoint Rank: Select Joint RankTenure Code: Select Code Joint Tenure Code: Select Joint CodeTenure Code Legend:N = Non-Tenure TrackM = Multi-Year ContractW = W-ContractAppointed or Promoted to Present Rank: Select Month – YearCourtesy Rank (if applicable): Select Courtesy RankProposed Personnel Action: Rank: Select RankJoint Rank: Select Joint RankTenure Code: Select Code Joint Tenure Code: Select Joint CodeFaculty Candidate Attestation: FORMCHECKBOX To the best of my knowledge, the information to which I have access that is provided in this dossier (i.e., non-confidential components) is true and accurate. FORMCHECKBOX I do not have a conflict of interest or a dual relationship with the Paper Preparer, as defined by Section 2.F.3 (Voting and Dual Relationships) and Section 3.D (Responsibility for the Case) of the Clinical Non-Tenure System Promotion and Tenure Guidelines, Part I: Campus Policies and Procedures. Faculty Candidate: Last, First Name & Middle (if applicable)Name (Print)SignatureDate Paper Preparer Attestation: FORMCHECKBOX To the best of my knowledge, the information to which I have access that is provided in this dossier (i.e., non-confidential components) is true and accurate. FORMCHECKBOX I do not have a conflict of interest or a dual relationship with the Candidate, as defined by Section 2.F.3 (Voting and Dual Relationships) and Section 3.D (Responsibility for the Case) of the Clinical Non-Tenure System Promotion and Tenure Guidelines, Part I: Campus Policies and Procedures. Paper Preparer: Last, First NameName (Print)SignatureDate Paper Preparer is also the Unit Executive Officer/Equivalent: FORMCHECKBOX YES FORMCHECKBOX NOENDORSEMENTS: UNIT, COLLEGE, AND CAMPUSCandidate: Last Name, First Name & Middle (if applicable) ENDORSEMENTNON-ENDORSEMENT(COMPLETE FOR APPLICABLE REVIEW LEVELS) FORMTEXT ????? FORMTEXT ????? FORMTEXT Type NameUnit Executive Officer (U.E.O.)/Equivalent Name/SignatureDate FORMTEXT ????? FORMTEXT ????? FORMTEXT Type NameJoint U.E.O./Equivalent Name /Signature (if applicable)Date FORMTEXT ????? FORMTEXT ????? FORMTEXT Type NameRegional Dean Name and Signature (if applicable) Date FORMTEXT ????? FORMTEXT ?????Mark I. Rosenblatt, MD, PhD, MBACollege Dean or Unit Director Name and SignatureDate FORMTEXT ????? FORMTEXT ????? FORMTEXT Type NameJoint Dean Name and Signature (if applicable)DateENDORSEMENT NON-ENDORSEMENT______________________________________________________________________________________Provost and Vice Chancellor for Academic Affairs DateENDORSEMENT NON-ENDORSEMENT______________________________________________________________________________________Vice Chancellor for Health AffairsDateTable of Contentscover Page1ENDORSEMENT PAGE………………………………………………………...................................................2 TOC \o "1-3" \h \z \u Table of Contents PAGEREF _Toc38027362 \h 3ACADEMIC AND EMPLOYMENT INFORMATION PAGEREF _Toc38027363 \h 51.Nature of Present Appointment PAGEREF _Toc38027364 \h 52.Education PAGEREF _Toc38027365 \h 53.Post-Doctoral Information PAGEREF _Toc38027366 \h 54.Licensing and/or Certifications PAGEREF _Toc38027367 \h 55.Academic & Professional Positions Since Terminal Degree and Post-Doctoral Training PAGEREF _Toc38027368 \h 6SUMMARY OF COMMITTEE REVIEWS PAGEREF _Toc38027369 \h 7Voting Justifications PAGEREF _Toc38027370 \h 8STATEMENT OF COLLEGE NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE PAGEREF _Toc38027371 \h 9STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE PAGEREF _Toc38027372 \h 10DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE TRACK FACULTY PAGEREF _Toc38027373 \h 11I. TEACHING ABILITY AND PERFORMANCE PAGEREF _Toc38027374 \h 12A. ACTIVITIES PAGEREF _Toc38027375 \h 121. Courses Taught PAGEREF _Toc38027376 \h 121.a. Annual Report of Faculty Teaching Effort at UIC– AY17-18 PAGEREF _Toc38027377 \h 131.a. Annual Report of Faculty Teaching Effort at UIC– AY18-19 PAGEREF _Toc38027378 \h 141.a. Annual Report of Faculty Teaching Effort at UIC– AY19-20 PAGEREF _Toc38027379 \h 152. Graduate Students PAGEREF _Toc38027380 \h 162.a. Graduate Student Advising and Supervision. PAGEREF _Toc38027381 \h 162.b. Graduate Student Exam Committee PAGEREF _Toc38027382 \h 163. Undergraduate Advising and Supervision: PAGEREF _Toc38027383 \h 164. Residents and Post-Doctoral Fellows Supervised. PAGEREF _Toc38027384 \h 175. Direction of Research Associates, Visiting Scholars, and Technicians. PAGEREF _Toc38027385 \h 176. Contributions to Instructional Techniques, Software and Teaching Materials: PAGEREF _Toc38027386 \h 187. Other Teaching Activities External to UIC: PAGEREF _Toc38027387 \h 188. Other Significant Teaching Recognition/Achievement not Covered in the Five-Year Period PAGEREF _Toc38027388 \h 18B. EVALUATION OF TEACHING AND RELATED ACTIVITIES PAGEREF _Toc38027389 \h 191. Summary of Student Evaluations of Faculty Teaching.* PAGEREF _Toc38027390 \h 192. Formal Recognition of Distinction in Teaching. PAGEREF _Toc38027391 \h 203. Candidate's Statement on Teaching Goals, Approaches and Accomplishments PAGEREF _Toc38027392 \h 21II. RESEARCH/SCHOLARSHIP ABILITY AND ACHIEVEMENT PAGEREF _Toc38027393 \h 22A. HONORS AND AWARDS ETC SINCE RECEIVING TERMINAL DEGREE PAGEREF _Toc38027394 \h 22B. INVITED COLLOQUIA AND SYMPOSIA PAGEREF _Toc38027395 \h 22C. OTHER INVITED PRESENTATIONS (e.g., LECTURES, WORKSHOPS, etc.) PAGEREF _Toc38027396 \h 22D. OTHER EVIDENCE OF RECOGNITION PAGEREF _Toc38027397 \h 22E. LICENSING/CERTIFICATION SINCE RECEIVING TERMINAL DEGREE PAGEREF _Toc38027398 \h 22F. SPONSORED RESEARCH ACTIVITIES PAGEREF _Toc38027399 \h 23G. PUBLICATIONS, PAPERS, AND OTHER SCIENTIFIC, CREATIVE OR SCHOLARLY WORKS PAGEREF _Toc38027400 \h 241. Publications or Other Creative Work Relevant to the Discipline (BEFORE) PAGEREF _Toc38027401 \h 242. Publications or Other Creative Work Relevant to the Discipline (SINCE) PAGEREF _Toc38027402 \h 253. Work Completed and Accepted for Publication. PAGEREF _Toc38027403 \h 264. Work in Progress PAGEREF _Toc38027404 \h 275. Papers and Poster Sessions Presented at Professional Meetings PAGEREF _Toc38027405 \h 296. Other Scientific Contributions, Creative or Scholarly Works PAGEREF _Toc38027406 \h 29H. OTHER SIGNIFICANT RESEARCH/SCHOLARSHIP RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD PAGEREF _Toc38027407 \h 29I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED RESEARCH, CREATIVE OR SCHOLARLY WORK PAGEREF _Toc38027408 \h 30III. SERVICE PAGEREF _Toc38027409 \h 31A. ADMINISTRATIVE RESPONSIBILITIES PAGEREF _Toc38027410 \h 31B. SERVICE TO THE DEPARTMENT/COLLEGE PAGEREF _Toc38027411 \h 31C. SERVICE TO THE UNIVERSITY PAGEREF _Toc38027412 \h 31D. SERVICE RELATED TO PATIENT CARE PAGEREF _Toc38027413 \h 31E. SERVICE RELATED TO STUDENTS PAGEREF _Toc38027414 \h 31F. SERVICE TO THE PROFESSION/DISCIPLINE PAGEREF _Toc38027415 \h 31G. PUBLIC SERVICE PAGEREF _Toc38027416 \h 31H. OTHER SIGNIFICANT SERVICE RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD PAGEREF _Toc38027417 \h 31I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED SERVICE ACTIVITIES PAGEREF _Toc38027418 \h 32IV. CANDIDATE'S STATEMENT OF INTERDISCIPLINARY WORK - OPTIONAL PAGEREF _Toc38027419 \h 33V. EVALUATIONS PAGEREF _Toc38027420 \h 34A. PEER EVALUATION OF FACULTY TEACHING PAGEREF _Toc38027421 \h 34Statement of Unit’s Policy for the Evaluation of Teaching PAGEREF _Toc38027422 \h 341.Peer Review of Classroom/Laboratory Teaching PAGEREF _Toc38027423 \h 352.Peer Review of Clinical Teaching PAGEREF _Toc38027424 \h 383.Letters from Former Trainees/Students and Peers PAGEREF _Toc38027425 \h 40B. EXTERNAL LETTERS OF REFERENCE PAGEREF _Toc38027426 \h 411. List of Referees Contacted PAGEREF _Toc38027427 \h 412. Copy of Letter(s) of Request for Referee’s Comments PAGEREF _Toc38027428 \h 413. List of all Materials Sent to Each Reviewer. PAGEREF _Toc38027429 \h 414. Referee’s Information PAGEREF _Toc38027430 \h 42C. LETTERS OF SUPPORT SOLICITED BY THE U.E.O./PAPER PREPARER (with input from the candidate) PAGEREF _Toc38027431 \h 47D. LETTER(S) FOR COURTESY APPOINTMENT(S) (IF APPLICABLE) PAGEREF _Toc38027432 \h 48E. EVALUATION FROM DEPARTMENTAL COMMITTEE PAGEREF _Toc38027433 \h 49F. EVALUATION FROM COLLEGE P&T COMMITTEE PAGEREF _Toc38027434 \h 50G. EVALUATION FROM COLLEGE’S PROCESS FOR REVIEW OF CLINICAL NON-TENURE TRACK FACULTY PAGEREF _Toc38027435 \h 51H. EVALUATION FROM UNIT EXECUTIVE OFFICER / EQUIVALENT PAGEREF _Toc38027436 \h 52I. EVALUATION FROM DEAN PAGEREF _Toc38027437 \h 531.Evaluation from Regional Dean (if applicable) PAGEREF _Toc38027438 \h 532.Evaluation from College Dean PAGEREF _Toc38027439 \h 54ACADEMIC AND EMPLOYMENT INFORMATION1.Nature of Present Appointmenta.Percentage of time (total UIC employment): 100% FORMCHECKBOX Other FORMCHECKBOX FORMTEXT ????? %2.Educationa. Highest degree: FORMTEXT ????? b. Year awarded: FORMTEXT ?????c.Institution: FORMTEXT ?????d. Department: FORMTEXT ?????e.Dissertation/thesis title: FORMTEXT ?????f.Thesis Advisor Name: FORMTEXT ?????3.Post-Doctoral Information(Clinicians should include residency/fellow training.)a.List Post-Doctoral appointments: FORMTEXT ?????b. Name of Post-doctoral Advisor: FORMTEXT ?????4.Licensing and/or CertificationsProvide a list of all professional licensing and/or certifications with dates. (If pending, give expected date of completion.)1) FORMTEXT ?????2) FORMTEXT ?????3) FORMTEXT ?????4) FORMTEXT ?????5) FORMTEXT ?????5.Academic & Professional Positions Since Terminal Degree and Post-Doctoral TrainingList in chronological order academic, professional, and other relevant positions held SINCE the terminal degree and Post-doctoral training, with inclusive dates, rank or title, and name of institution. Include information for appointment at UIC and account for gaps in academic career, if pertinent. If necessary, attach extra page(s). It is not necessary to add page numbers in this section.#DatesRank/TitleInstitution/Organization1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????11 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????12 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????13 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????14 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????15 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????SUMMARY OF COMMITTEE REVIEWSCandidate: Last Name, First Name & Middle (if applicable) College: Select College for Primary AppointmentRegional Site: Select Regional SiteJoint Appt. College: Select Joint CollegeUnit(s): FORMTEXT For Joint Appts. List All Units with (%FTE) Next to each UnitUnit P&T Committee Review:* Give a figure (“0”, if appropriate) in each of the six categories*Total # of Members YES NO ABSTAINABSENTNOT ELIGIBLE** FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Name of Chair: FORMTEXT ?????Signature:Date: Joint Unit P&T Committee Review (if applicable):* Give a figure (“0”, if appropriate) in each of the six categories*Total # of Members YES NO ABSTAINABSENTNOT ELIGIBLE** FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Name of Chair: FORMTEXT ?????Signature:Date: Joint College or Regional Site P&T Committee Review (if applicable):* Give a figure (“0”, if appropriate) in each of the six categories*Total # of Members YES NO ABSTAINABSENTNOT ELIGIBLE** FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Name of Chair: FORMTEXT ?????Signature:Date: College P&T Committee Review:* Give a figure (“0”, if appropriate) in each of the six categories*Total # of Members YES NO ABSTAINABSENTNOT ELIGIBLE** FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Name of Chair: FORMTEXT ?????Signature:Date: College Executive Committee P&T Review (if applicable):* Give a figure (“0”, if appropriate) in each of the six categories*Total # of Members YES NO ABSTAINABSENTNOT ELIGIBLE** FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Name of Chair: FORMTEXT ?????Signature:Date: Campus P&T Committee Review:* Give a figure (“0”, if appropriate) in each of the six categories*Total # of Members YES NO ABSTAINABSENTNOT ELIGIBLE** FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Name of Chair: FORMTEXT ?????Signature:Date: Voting Justifications**Include brief explanation(s) as to why members were “Not Eligible” (NE) to vote for each level and/or include Voting Justifications if needed, as inserted page(s) in the PDF. It is not necessary to add page numbers in this mittee members are considered Not Eligible (NE) to vote if they have voted at a previous level in the process or if the proposed rank of the candidate is greater than their own.STATEMENT OF COLLEGE NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE**Include Statements for all Ranks within the Clinical Discipline Non-Tenure TrackNOTE: please insert the information for the appropriate track from the College of Medicine Norms Statements – (May be included as separate page(s). It is not necessary to add page numbers in this section.)STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE**Include Statements for all Ranks within the Clinical Discipline Non-Tenure Track(Include as separate page(s). It is not necessary to add page numbers in this section.)If the unit does not have department-specific norms, indicate that the department follows the College of Medicine Norms.DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE TRACK FACULTYThe College of Medicine does not have a separate process for peer evaluation of full-time clinical non-tenured track faculty at the College level.**If the department has a separate process, include it below or as a separate page(s).It is not necessary to add page numbers in this section.I. TEACHING ABILITY AND PERFORMANCEIn chronological order, list courses taught by the candidate SINCE the last personnel action. (post-doctoral data may not be included). Note any release time for sabbatical, fellowships or any other reason.A. ACTIVITIES1. Courses TaughtComplete below if applicable."Required" refers to courses that all students must take in order to complete a degree program or specialization, including minors and/or concentrations. “Selective” refers to courses that are on a list of two or more courses from which the student must select one or more in order to complete a degree program or specialization. “Elective” refers to courses that are not required for any degree but which may be used toward elective hours in a degree program.#Semester/ TermCourse #Course TitleTeam Taught(Yes/No)Credit HoursRequired/Selective/ ElectiveEnrollment1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? 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FORMTEXT ?????14 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????15 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????16 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????17 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????18 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????19 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????20 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????21 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????22 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????23 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????24 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????25 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.a. Annual Report of Faculty Teaching Effort at UIC– AY17-18Name: FORMTEXT ?????Department: FORMTEXT ?????Date report prepared: FORMTEXT ?????DESCRIPTION OF TEACHING ACTIVITIES(Provide additional detail in the sections cited in parentheses.)ScheduledContactHours perYearPreparationHours perYearTotal Hoursper Year1.0Course and program planning, organization and coordination1.1Classroom/Laboratory course FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.2Clinical clerkship FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.3Residency or fellowship FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.4Continuing medical education FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.0Lectures and seminars2.1Course leading to profession or graduate degree FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.2Course for residents or fellows FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.3Continuing medical education FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.4Course leading to undergraduate degree FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.5Course leading to technical certificate FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3.0Laboratory or other scheduled small group teaching3.1Planner, coordinator, supervisor of the session FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3.2Supportive role in laboratory or small group session FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.0Clinical teaching/attending4.1Undergraduate clinical teaching FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.2Resident teaching rounds FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.3Combined resident/medical student rounds FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.4Ad hoc clinical teaching FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.0Research training/independent study5.1Medical student FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.2Masters degree candidates FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.3Ph.D. candidate FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.4Resident FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.5Postdoctoral fellow FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6.0Counseling/guidance6.1Medical or graduate student FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6.2Resident or fellow FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.0Educational committee work7.1Local education committee FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.2College/campus education committee FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.3Education committee for national organization FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8.0Curriculum development FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9.0Other (describe on a continuation page) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TOTALS FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Please note: One report for each of the three years prior to review should be provided. Hours attributed to teaching should correspond to the % effort engaged in teaching, and be reported separately from clinical and research time. FORMTEXT (type Faculty Member name here)(signature) FORMTEXT (type Dept/Head name here)(signature)Faculty MemberDepartment/Head 1.a. Annual Report of Faculty Teaching Effort at UIC– AY18-19Name: FORMTEXT ?????Department: FORMTEXT ?????Date report prepared: FORMTEXT ?????DESCRIPTION OF TEACHING ACTIVITIES(Provide additional detail in the sections cited in parentheses.)ScheduledContactHours perYearPreparationHours perYearTotal Hoursper Year1.0Course and program planning, organization and coordination1.1Classroom/Laboratory course FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.2Clinical clerkship FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.3Residency or fellowship FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.4Continuing medical education FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.0Lectures and seminars2.1Course leading to profession or graduate degree FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.2Course for residents or fellows FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.3Continuing medical education FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.4Course leading to undergraduate degree FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.5Course leading to technical certificate FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3.0Laboratory or other scheduled small group teaching3.1Planner, coordinator, supervisor of the session FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3.2Supportive role in laboratory or small group session FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.0Clinical teaching/attending4.1Undergraduate clinical teaching FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.2Resident teaching rounds FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.3Combined resident/medical student rounds FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.4Ad hoc clinical teaching FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.0Research training/independent study5.1Medical student FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.2Masters degree candidates FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.3Ph.D. candidate FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.4Resident FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.5Postdoctoral fellow FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6.0Counseling/guidance6.1Medical or graduate student FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6.2Resident or fellow FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.0Educational committee work7.1Local education committee FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.2College/campus education committee FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.3Education committee for national organization FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8.0Curriculum development FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9.0Other (describe on a continuation page) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TOTALS FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Please note: One report for each of the three years prior to review should be provided. Hours attributed to teaching should correspond to the % effort engaged in teaching, and be reported separately from clinical and research time. FORMTEXT (type Faculty Member name here)(signature) FORMTEXT (type Dept/Head name here)(signature)Faculty MemberDepartment/Head1.a. Annual Report of Faculty Teaching Effort at UIC– AY19-20Name: FORMTEXT ?????Department: FORMTEXT ?????Date report prepared: FORMTEXT ?????DESCRIPTION OF TEACHING ACTIVITIES(Provide additional detail in the sections cited in parentheses.)ScheduledContactHours perYearPreparationHours perYearTotal Hoursper Year1.0Course and program planning, organization and coordination1.1Classroom/Laboratory course FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.2Clinical clerkship FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.3Residency or fellowship FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????1.4Continuing medical education FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.0Lectures and seminars2.1Course leading to profession or graduate degree FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.2Course for residents or fellows FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.3Continuing medical education FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.4Course leading to undergraduate degree FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.5Course leading to technical certificate FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3.0Laboratory or other scheduled small group teaching3.1Planner, coordinator, supervisor of the session FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3.2Supportive role in laboratory or small group session FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.0Clinical teaching/attending4.1Undergraduate clinical teaching FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.2Resident teaching rounds FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.3Combined resident/medical student rounds FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.4Ad hoc clinical teaching FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.0Research training/independent study5.1Medical student FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.2Masters degree candidates FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.3Ph.D. candidate FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.4Resident FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.5Postdoctoral fellow FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6.0Counseling/guidance6.1Medical or graduate student FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6.2Resident or fellow FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.0Educational committee work7.1Local education committee FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.2College/campus education committee FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7.3Education committee for national organization FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8.0Curriculum development FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9.0Other (describe on a continuation page) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TOTALS FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Please note: One report for each of the three years prior to review should be provided. Hours attributed to teaching should correspond to the % effort engaged in teaching, and be reported separately from clinical and research time. FORMTEXT (type Faculty Member name here)(signature) FORMTEXT (type Dept/Head name here)(signature)Faculty MemberDepartment/Head2. Graduate Students2.a. Graduate Student Advising and Supervision. FORMCHECKBOX Check here if none and explain#Name of StudentBeginning and Completion DatesDegree; Thesis Title; Role(Chair, advisor, or committee member)1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2.b. Graduate Student Exam Committee FORMCHECKBOX Check here if none#Academic Year# of Committees1 FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ?????3. Undergraduate Advising and Supervision:Including that related to medical students and to the Honors College. (List service and activities related to student organizations in Section 3, E) FORMCHECKBOX Check here if none#Name of StudentSemester and YearNature of Advising/Supervision (e.g. – independent study, Honors College Capstone, Honors College Fellow work)1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4. Residents and Post-Doctoral Fellows Supervised. FORMCHECKBOX Check here if none#NameBeginning and Ending DatesNature of Supervision1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5. Direction of Research Associates, Visiting Scholars, and Technicians. FORMCHECKBOX Check here if none#Name of Research AssociatesBeginning and Ending DatesNature of Supervision1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Check here if none#Name of Visiting ScholarsBeginning and Ending DatesNature of Supervision1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Check here if none#Name of TechniciansBeginning and Ending DatesNature of Supervision1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6. Contributions to Instructional Techniques, Software and Teaching Materials:Include the creation and implementation of new courses.The candidate should describe any special instructional techniques and new teaching materials he or she has developed. Indicate other unique contributions to instruction. The importance of innovation in instructional materials, as might be demonstrated by the creation of a new course, is recognized. FORMCHECKBOX Check here if none FORMTEXT ?????7. Other Teaching Activities External to UIC:Include the location of the course, name/description of the course, dates taught, credit hours, and number of students enrolled. FORMCHECKBOX Check here if none FORMTEXT ?????8. Other Significant Teaching Recognition/Achievement not Covered in the Five-Year Period FORMCHECKBOX Check here if none FORMTEXT ?????B. EVALUATION OF TEACHING AND RELATED ACTIVITIES At a minimum, information should be provided for courses taught in the past year.1. Summary of Student Evaluations of Faculty Teaching.**It is inappropriate to ask current doctoral students or trainees supervised by the candidate to write a teaching evaluation for the candidate. Summarize below the results of student evaluations of the candidate's overall teaching effectiveness for each teaching activity. Use forms from the Manual for Evaluating Teaching in the College of Medicine () for Student Evaluation of Classroom/Lab Teaching or Student Evaluation of Clinical Teaching as appropriate to gather the basic data. DEPARTMENTS MAY USE AN ALTERNATE FORM FOR SUMMARIZING STUDENT EVALUATIONS; HOWEVER, STUDENT EVALUATIONS MUST BE PRESENTED AS SUMMARIZED DATA. If narrative comments from student evaluations are included, all comments from all students in that course should be provided.#Semester/TermCourse NumberCourse Title*Average Rating+ SD(n/N)1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????11 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????12 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????13 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????14 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????15 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????16 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????17 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????18 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????19 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????20 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????21 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????22 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????23 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????24 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????25 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????*Average of students' ratings of the "Overall Teaching Effectiveness" (or equivalent) of the candidate, on a scale of 5 (Excellent) to 1 (Poor). SD = standard deviation; n = number of students who rated thecandidate in that course; N = total number of students in that course.2. Formal Recognition of Distinction in Teaching.Please indicate nature of and criteria for recognition as well as the dates of awards. FORMCHECKBOX Check here if none FORMTEXT ?????3. Candidate's Statement on Teaching Goals, Approaches and AccomplishmentsThe candidate should explain his/her philosophy of education, describe the place of teaching in his/her career goals, assess his/her progress toward those goals, and describe his/her plan for future teaching activities. (Fit on one page; no smaller than 10 pt font. It can be included as a separate page. It is not necessary to add page numbers in this section. FORMTEXT ?????II. RESEARCH/SCHOLARSHIP ABILITY AND ACHIEVEMENT A. HONORS AND AWARDS ETC SINCE RECEIVING TERMINAL DEGREE(List in chronological order) FORMCHECKBOX Check here if none FORMTEXT ?????B. INVITED COLLOQUIA AND SYMPOSIA These must be invited. In chronological order, list invited colloquia/symposia since last personnel action and please describe and specify the significance of each colloquium/symposium listed. (post-doctoral data may not be included). (Do NOT list here presentations at professional meetings but place them under G.5) FORMCHECKBOX Check here if none FORMTEXT ?????C. OTHER INVITED PRESENTATIONS (e.g., LECTURES, WORKSHOPS, etc.)These must be invited. In chronological order, list other invited presentations since last personnel action and please describe and specify the significance of each presentation listed. (post-doctoral data may not be included). (Do NOT list here presentations at professional meetings but place them under G.5) FORMCHECKBOX Check here if none FORMTEXT ?????D. OTHER EVIDENCE OF RECOGNITIONIn chronological order, list other evidence of recognition since last personnel action. For faculty who are on a Q contract; who are in the non-tenure track having switched from the tenure track; who were moved into the tenure track from the non-tenure track; or who started their probationary year higher than T1, please include data since the last personnel action or for the past five years, whichever period is longer (post-doctoral data may not be included). FORMCHECKBOX Check here if none FORMTEXT ?????E. LICENSING/CERTIFICATION SINCE RECEIVING TERMINAL DEGREE FORMCHECKBOX Check here if none FORMTEXT ?????F. SPONSORED RESEARCH ACTIVITIES In chronological order, list sponsored research activities for a period not longer than the most recent five years (post-doctoral data may not be included). List all grant applications, even if unfunded.For faculty who are on a Q contract; who are in the non-tenure track having switched from the tenure track; who were moved into the tenure track from the non-tenure track; or who started their probationary year higher than T1, please include data since the last personnel action or for the past five years, whichever period is longer (post-doctoral data may not be included).?#Date ofSubmissionRole of Candidate*AgencyTitle of Proposal and Type of Grant Where ApplicableAmount**RequestedAmount**FundedFunding Period1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????11 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????12 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????13 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????14 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????15 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????16 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????17 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????18 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????19 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????20 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????*List PI name, if other than candidate.**In multi-investigator projects, list both total amount and amount attributable to candidate, e.g., $375,750/$123,000. Indicate whether amount is total cost (TC), i.e. direct + indirect, or total direct cost (TDC). Funding and submissions are subject to verification by the Office of the Vice Chancellor for Research. G. PUBLICATIONS, PAPERS, AND OTHER SCIENTIFIC, CREATIVE OR SCHOLARLY WORKSFor faculty who switched from the tenure-track to the clinical non-tenure track, please include data since last personnel action or the last 5 years, whichever period is longer (post-doctoral data may not be included).List in chronological order. Include: books, monographs, edited volumes and translations, articles refereed in journals (do not abbreviate titles; give inclusive page numbers. If there is a certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice), other articles (give inclusive page numbers) including bulletins, technical reports, chapters in books, book reviews, creative works (e.g., poetry, composition, exhibitions), patents, or other publications such as notes and comments. Underline senior author in all categories, and asterisk (*) refereed publications if listed in categories other than c. The senior author is defined as the major contributor to the publication. If there is a certain significance in the order of authors in multi-authored publications in the discipline, please provide a brief summary of the practice. 1. Publications or Other Creative Work Relevant to the Discipline (BEFORE) Dated BEFORE Last Personnel Action (A personnel action is defined as the initial appointment date or effective date of most recent promotion or track switch). a.Books and monographs FORMCHECKBOX Check here if none FORMTEXT ?????b.Edited volumes and translations FORMCHECKBOX Check here if none FORMTEXT ?????c.Articles in refereed journals (Do not abbreviate titles; give inclusive page numbers.If there is certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????d.Refereed abstracts and conference proceeding articles(Do not abbreviate titles; give inclusive page numbers. If there is certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????e.Other articles, including bulletins and technical reports (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????f.Chapters in books (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????g.Book reviews (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????h.Creative works(e.g., poetry, composition, exhibitions) FORMCHECKBOX Check here if none FORMTEXT ?????i.Patents FORMCHECKBOX Check here if none FORMTEXT ?????j.Other (e.g., notes and comments) FORMCHECKBOX Check here if none FORMTEXT ?????2. Publications or Other Creative Work Relevant to the Discipline (SINCE) Dated SINCE Last Personnel Action (A personnel action is defined as the initial appointment date or effective date of most recent promotion or track switch).a.Books and monographs FORMCHECKBOX Check here if none FORMTEXT ?????b.Edited volumes and translations FORMCHECKBOX Check here if none FORMTEXT ?????c.Articles in refereed journals (Do not abbreviate titles; give inclusive page numbers.If there is a certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????d.Refereed abstracts and conference proceeding articles(Do not abbreviate titles; give inclusive page numbers. If there is certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????e.Other articles, including bulletins and technical reports (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????f.Chapters in books (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????g.Book reviews (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????h.Creative works(e.g., poetry, composition, exhibitions) FORMCHECKBOX Check here if none FORMTEXT ?????i.Patents FORMCHECKBOX Check here if none FORMTEXT ?????j.Other (e.g., notes and comments) FORMCHECKBOX Check here if none FORMTEXT ?????3. Work Completed and Accepted for Publication. Do NOT include here provisionally accepted work or work submitted but not yet accepted. List, instead, under F.4.Underline senior author in all categories, and asterisk (*) refereed publications if listed in categories other than c. The senior author is defined as the major contributor to the publication. If there is a certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice.a.Books and monographs FORMCHECKBOX Check here if none FORMTEXT ?????b.Edited volumes and translations FORMCHECKBOX Check here if none FORMTEXT ?????c.Articles in refereed journals (Do not abbreviate titles; give inclusive page numbers. If there is a certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????d.Refereed abstracts and conference proceeding articles(Do not abbreviate titles; give inclusive page numbers. If there is certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????e.Other articles, including bulletins and technical reports (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????f.Chapters in books (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????g.Book reviews (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????h.Creative works(e.g., poetry, composition, exhibitions) FORMCHECKBOX Check here if none FORMTEXT ?????i.Patents FORMCHECKBOX Check here if none FORMTEXT ?????j.Other (e.g., notes and comments) FORMCHECKBOX Check here if none FORMTEXT ?????4. Work in Progress Add the designation “Submitted” to works presently under review but not yet accepted.Underline senior author in all categories, and asterisk (*) refereed publications if listed in categories other than c. The senior author is defined as the major contributor to the publication. If there is a certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice.a.Books and monographs FORMCHECKBOX Check here if none FORMTEXT ?????b.Edited volumes and translations FORMCHECKBOX Check here if none FORMTEXT ?????c.Articles in refereed journals (Do not abbreviate titles; give inclusive page numbers. If there is a certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????d.Refereed abstracts and conference proceeding articles(Do not abbreviate titles; give inclusive page numbers. If there is certain significance in the order of authors in multi-author publications in the discipline, please provide a brief summary of the practice). FORMCHECKBOX Check here if none FORMTEXT ?????e.Other articles, including bulletins and technical reports (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????f.Chapters in books (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????g.Book reviews (Give inclusive page numbers.) FORMCHECKBOX Check here if none FORMTEXT ?????h.Creative works(e.g., poetry, composition, exhibitions) FORMCHECKBOX Check here if none FORMTEXT ?????i.Patents FORMCHECKBOX Check here if none FORMTEXT ?????j.Other (e.g., notes and comments) FORMCHECKBOX Check here if none FORMTEXT ?????5. Papers and Poster Sessions Presented at Professional MeetingsIn chronological order, list papers and poster sessions presented at professional meetings since last personnel action. (post-doctoral data may not be included). (Clearly label poster sessions). FORMCHECKBOX Check here if none FORMTEXT ?????6. Other Scientific Contributions, Creative or Scholarly Works In chronological order list other scientific, creative or scholarly works since last personnel action. (post-doctoral data may not be included). FORMCHECKBOX Check here if none FORMTEXT ?????H. OTHER SIGNIFICANT RESEARCH/SCHOLARSHIP RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD(Post-Doctoral data may not be included)I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED RESEARCH, CREATIVE OR SCHOLARLY WORK NOTE: Recognize that reviewers later in the process are not disciplinary specialists. (Fit on one page; no smaller than 10 pt font. It can be included as a separate page. It is not necessary to add page numbers in this section. III. SERVICEIn chronological order, list administrative responsibilities since last personnel action. Please include data since the last personnel action or for the past five years, whichever period is longer (post-doctoral data may not be included).A. ADMINISTRATIVE RESPONSIBILITIES FORMCHECKBOX Check here if none. FORMTEXT ?????B. SERVICE TO THE DEPARTMENT/COLLEGE FORMCHECKBOX Check here if none. FORMTEXT ?????C. SERVICE TO THE UNIVERSITY FORMCHECKBOX Check here if none. FORMTEXT ?????D. SERVICE RELATED TO PATIENT CAREUse this section to provide a detailed summary of the candidate’s contributions to university-related patient care services. Describe how clinical time is allocated, patient load/schedule, referral base, etc. Support letters from colleagues who can evaluate the candidate’s contributions to patient care and the health care team may be appended to this section. FORMCHECKBOX Check here if none. FORMTEXT ?????E. SERVICE RELATED TO STUDENTS Use this section to present activities related to student organizations, etc.; (include student, academic, and research advising in SECTION I - TEACHING ABILITY AND PERFORMANCE) FORMCHECKBOX Check here if none. FORMTEXT ?????F. SERVICE TO THE PROFESSION/DISCIPLINE Use this section to describe non-university professional activities such as offices held in professional organizations, editorships, and other activities (i.e., grant review activity) from which the candidate gains national or international recognition. (See Part III, “Instructions,” Section 5.III. F.) FORMCHECKBOX Check here if none. FORMTEXT ?????G. PUBLIC SERVICE FORMCHECKBOX Check here if none. FORMTEXT ?????H. OTHER SIGNIFICANT SERVICE RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD(post-doctoral data may not be included) FORMCHECKBOX Check here if none. FORMTEXT ?????I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED SERVICE ACTIVITIES NOTE: The candidate should explain how these efforts fit into the department norms and policies. (Fit on one page; no smaller than 10 pt. font. It can be included as a separate page. It is not necessary to add page numbers in this section. FORMTEXT ?????IV. CANDIDATE'S STATEMENT OF INTERDISCIPLINARY WORK - OPTIONAL NOTE: The candidate should explain the nature of any interdisciplinary work. (Fit on one page; no smaller than 10 pt. font. It can be included as a separate page. It is not necessary to add page numbers in this section. FORMTEXT ?????V. EVALUATIONSA. PEER EVALUATION OF FACULTY TEACHINGEvaluation of teaching activities must be included since the last personnel action period. They may be done by the unit executive officer, discipline coordinator, unit director, or by other senior faculty members who are recognized as excellent teachers. These peer evaluations should address such things as an instructor's ability to present course content and/or skills to students, the appropriate level of difficulty of material presented, relevance of examples, integration of topics, structure of the teaching session, and congruence between course goals and accomplishments.Confidential letters of evaluation obtained from former trainees should be included in this section.Statement of Unit’s Policy for the Evaluation of TeachingExplain how this is done and on what schedule. FORMTEXT ?????Peer Review of Classroom/Laboratory TeachingUse the College evaluation form for Peer Review of Classroom/Laboratory Teaching to gather the basic data, and summarize the results on this form. Calculate the average numeric score from each rater for the overall categories. DO NOT INCLUDE THE ACTUAL QUESTIONNAIRES. If narrative comments from peer evaluators are made, include the written statements.Rating Scale: 5 = Excellent, 4 = Above Average, 3 = Good, 2 = Fair, 1 = Poor, N = Not Applicablea.Evaluation of Written Material FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentb.Evaluation of Lecture FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????comment1.Peer Review of Classroom/Laboratory Teaching - continuedRating Scale: 5 = Excellent, 4 = Above Average, 3 = Good, 2 = Fair, 1 = Poor, N = Not Applicablec.Evaluation of Small Group Interactions FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentd.Enthusiasm and Intellectual Stimulation FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commente.Appropriateness of Content for the Intended Audience FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????comment1.Peer Review of Classroom/Laboratory Teaching - continuedRating Scale: 5 = Excellent, 4 = Above Average, 3 = Good, 2 = Fair, 1 = Poor, N = Not Applicablef.Course Administration (For Course Coordinator) FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentg.Overall Teaching Effectiveness FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commenth.Additional Comments from Evaluators FORMCHECKBOX Check here if not applicable FORMTEXT ?????Peer Review of Clinical TeachingUse the College evaluation form for Peer Review of Clinical Teaching to gather the basic date, and summarize the results of this form. Calculate the average numeric score from each reviewer for the overall categories. DO NOT INCLUDE THE ACTUAL QUESTIONNAIRES. If narrative comments from peer evaluators are made, include the written statements.Rating Scale: 5 = Excellent, 4 = Above Average, 3 = Good, 2 = Fair, 1 = Poor, N = Not Applicablea.Learning Climate FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentb.Control of Session FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????comment2.Peer Review of Clinical Teaching - continuedRating Scale: 5 = Excellent, 4 = Above Average, 3 = Good, 2 = Fair, 1 = Poor, N = Not Applicablec.Clinical Skills, Knowledge and Attitudes FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentd.Overall Teaching Effectiveness FORMCHECKBOX Check here if not applicablereviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commentreviewer FORMTEXT ?????rating FORMTEXT ????commente.Additional Comments from Evaluators FORMCHECKBOX Check here if not applicable FORMTEXT ?????Letters from Former Trainees/Students and PeersEvaluation of the candidate’s overall teaching effectiveness should be solicited from former students/trainees and/or peers. [It is inappropriate to ask current doctoral students or trainees supervised by the candidate to write a teaching evaluation for the candidate.]These evaluations are to be solicited by the department head/chair or designee, not the candidate (though the candidate may suggest reviewers). There should be no fewer than 3 letters.Evaluators should be asked to describe their exposure to the candidate’s teaching, to assess the candidate’s overall teaching effectiveness on a scale of 5 (Excellent) to 1 (Poor), and to justify that assessment. FORMCHECKBOX Check here if noneInsert confidential letters of evaluation from former trainees/students and peers on following page(s). It is not necessary to add page numbers in this section.List names of individuals who have provided letters below..B. EXTERNAL LETTERS OF REFERENCEAll communications pertaining to the initial requests for an evaluation of the candidate and replies that were sent and received by the Unit must be included in the candidate’s file, even if the reviewer’s letter is a simple statement of inability or unwillingness to serve.1. List of Referees Contacteda. Those Who Accepted: FORMTEXT ?????b. Those Who Declined: FORMTEXT ?????c. Those Who Did Not Respond: FORMTEXT ?????2. Copy of Letter(s) of Request for Referee’s CommentsInsert one copy of letter requesting referee's comments, including one copy (if applicable) of all communications inquiring whether the referee is willing to serve. (See sample letter of request included in Part III, “Instructions” Section 7, V.B). FORMTEXT ?????3. List of all Materials Sent to Each Reviewer. (May be omitted here, if this information is contained in the sample letter under number 2 above). Full citations for sample publications must be provided. In the case of unpublished materials, it should be clearly specified in what form and how much material was sent (outline, draft, proofs, etc.). FORMTEXT ?????4. Referee’s InformationProvide the information below for each Referee. Each Letter from a Referee should follow the Referee’s Information Page. Delete any unneeded Information pages.a. Referee 1Name of Referee: FORMTEXT ?????Brief Biographical Sketch of Referee: FORMTEXT ?????How was this referee selected? FORMTEXT ?????Specify referee's relationship to the Candidate: (In fields that are small where acquaintance is not unusual, a statement to this effect must be provided by the department.) FORMTEXT ?????**Insert letters from referees on following page(s). It is not necessary to add page numbers in this section.b. Referee 2Name of Referee: FORMTEXT ?????Brief Biographical Sketch of Referee: FORMTEXT ?????How was this referee selected? FORMTEXT ?????Specify referee's relationship to the Candidate: (In fields that are small where acquaintance is not unusual, a statement to this effect must be provided by the department.) FORMTEXT ?????**Insert letters from referees on following page(s). It is not necessary to add page numbers in this section.c. Referee 3Name of Referee: FORMTEXT ?????Brief Biographical Sketch of Referee: FORMTEXT ?????How was this referee selected? FORMTEXT ?????Specify referee's relationship to the Candidate: (In fields that are small where acquaintance is not unusual, a statement to this effect must be provided by the department.) FORMTEXT ?????**Insert letters from referees on following page(s). It is not necessary to add page numbers in this section.d. Referee 4Name of Referee: FORMTEXT ?????Brief Biographical Sketch of Referee: FORMTEXT ?????How was this referee selected? FORMTEXT ?????Specify referee's relationship to the Candidate: (In fields that are small where acquaintance is not unusual, a statement to this effect must be provided by the department.) FORMTEXT ?????**Insert letters from referees on following page(s). It is not necessary to add page numbers in this sectione. Referee 5Name of Referee: FORMTEXT ?????Brief Biographical Sketch of Referee: FORMTEXT ?????How was this referee selected? FORMTEXT ?????Specify referee's relationship to the Candidate: (In fields that are small where acquaintance is not unusual, a statement to this effect must be provided by the department.) FORMTEXT ?????**Insert letters from referees on following page(s). It is not necessary to add page numbers in this section.)C. LETTERS OF SUPPORT SOLICITED BY THE U.E.O./PAPER PREPARER (with input from the candidate)(Optional)Letters of support for the candidate are optional and may be included from past or present scholarly/research/clinical colleagues, former graduate and post-doctoral advisors/mentors, and any relevant others. **Insert letters of support on following page(s). It is not necessary to add page numbers in this section.List names of individuals who have provided letters below.D. LETTER(S) FOR COURTESY APPOINTMENT(S) (IF APPLICABLE)(If Applicable)Paper preparer(s) must solicit letters from the Unit Executive Officer(s) of the Unit(s) in which the candidate holds a Courtesy Appointment. Letters should document the contributions of the candidate in the courtesy unit.**Insert letters on the following page(s). It is not necessary to add page numbers in this section.E. EVALUATION FROM DEPARTMENTAL COMMITTEE (IF APPLICABLE – if there is a disagreement between the Unit P&T Committee and the Unit Executive Officer)**Insert evaluation from departmental committee on the following page(s). It is not necessary to add page numbers in this section.F. EVALUATION FROM COLLEGE P&T COMMITTEE (IF APPLICABLE – if there is a disagreement between the College P&T Committee and the Dean)**Insert evaluation from college committee on the following page(s). It is not necessary to add page numbers in this section. G. EVALUATION FROM COLLEGE’S PROCESS FOR REVIEW OF CLINICAL NON-TENURE TRACK FACULTY(IF APPLICABLE – if the college has a process, include it, if not, indicate that the college does not have a separate process.)**Insert evaluation on the following page(s). It is not necessary to add page numbers in this section.The College of Medicine does not have a separate process for review of clinical non-tenure faculty in the Clinical Discipline track.H. EVALUATION FROM UNIT EXECUTIVE OFFICER / EQUIVALENTCandidate: FORMTEXT ?????Date: FORMTEXT ????? College: MedicineDepartment: FORMTEXT ?????Unit Executive Officer/Equivalent is also the Paper Preparer: FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX I support the proposed personnel action for the reasons detailed below. FORMCHECKBOX I do not support the proposed personnel action for the reasons detailed belowJUSTIFICATION FOR RECOMMENDATION(Evaluation must address split votes at the department level and should be organized under the following five subheadings.)1. Appraisal of Candidate’s Teaching Record (Comment on the candidate's overall teaching ability, including the extent to which the candidate has matured in teaching effectiveness over the time period considered. Justify the assessment.) FORMTEXT ?????2. Appraisal of Candidate’s Contribution to Curriculum and Other Instructional Materials or Products (Describe and assess the candidate's contributions to curriculum.) FORMTEXT ?????3. Appraisal of Candidate’s Research and Scholarship, Including Contributions (if any) to Collaborative Research. (Provide an assessment of the quality of the publication outlets, giving objective rankings of presses and journals where available.) FORMTEXT ?????4. Appraisal of Candidate’s Service Record (Justify this assessment and attach any supporting documents.) FORMTEXT ?????5. Overall Assessment and Justification for Recommendation FORMTEXT ????? FORMTEXT U.E.O NameUnit Executive Officer /Equivalent U.E.O./Equivalent (signature) (Place name and signature on the last page only)I. EVALUATION FROM DEAN Evaluation from Regional Dean (if applicable)Candidate: FORMTEXT ?????Date: FORMTEXT ????? College: MedicineDepartment: FORMTEXT ????? FORMCHECKBOX I support the proposed personnel action for the reasons detailed below. FORMCHECKBOX I do not support the proposed personnel action for the reasons detailed belowJUSTIFICATION FOR RECOMMENDATION(Evaluation must address split votes at the college/college executive level) FORMTEXT Dean's NameRegional DeanRegional Dean (signature) (Place name and signature on the last page only)Evaluation from College DeanCandidate: FORMTEXT ?????Date: FORMTEXT ????? College: MedicineDepartment: FORMTEXT ????? FORMCHECKBOX I support the proposed personnel action for the reasons detailed below. FORMCHECKBOX I do not support the proposed personnel action for the reasons detailed belowJUSTIFICATION FOR RECOMMENDATION(Evaluation must address split votes at the college/college executive level)Mark I. Rosenblatt, MD, PhD, MBACollege DeanCollege Dean (signature) (Place name and signature on the last page only) ................
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