UIC COLLEGE OF MEDICINE
EXPEDITED Q CONTRACT
ACADEMIC YEAR: ______
*CANDIDATE’S PERSONNEL/APPOINTMENT INFO. MUST BE ENTERED AS LISTED IN BANNER/HR FRONT END*
Candidate: Last Name, First Name & Middle (if applicable)
UIN #: UIN #
College: Medicine
Regional Site: Select Regional Site
Department: Unit Name
%FTE: %FTE%
Joint or Courtesy Appt: Unit Name
%FTE: %FTE%
Present Appointment:
Rank: Select Rank
Tenure Code Legend:
A = Tenure
1-6 = Tenure Track Year
Q = Q-Contract
Tenure Code: Select Code
Month/Year Appointed/Promoted to Present Rank:
Proposed Personnel Action:
Rank: Select Rank
Tenure Code: Q
I have read the Promotion and Tenure Policies and Procedures:
Faculty Candidate:
Last, First Name & Middle (if applicable)
Name (Print)
Paper Preparer:
Date
Signature
Date
Last, First Name
Name (Print)
Paper Preparer is also the Unit Executive Officer/Equivalent:
ENDORSEMENT
Signature
NON-ENDORSEMENT
YES
NO
(COMPLETE FOR APPLICABLE REVIEW LEVELS)
Type Name
Unit Executive Officer (U.E.O.)/Equivalent Name/Signature Date
Type Name
Joint U.E.O./Equivalent Name /Signature (if applicable)
Date
Type Name
Regional Dean Name and Signature (if applicable)
Date
Dimitri T. Azar, MD
College Dean or Unit Director Name and Signature
1
Date
Table of Contents for Materials Contained in the Expedited Q Contract Dossier
COVER SHEET ..................................................................................................................................................................... 1
I.
INFORMATION SUMMARY FORM .......................................................................................................................... 3
II. SUMMARY OF COMMITTEE REVIEWS................................................................................................................. 5
III. STATEMENT OF COLLEGE/UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE .... 6
IV. CANDIDATE'S PERSONAL STATEMENT ON TEACHING, RESEARCH AND SERVICE ............................. 7
V. EVALUATIONS ............................................................................................................................................................. 8
A.
B.
C.
D.
E.
F.
EXTERNAL LETTERS OF REFERENCE ........................................................................................................................... 8
EVALUATION FROM DEPARTMENAL P&T COMMITTEE ............................................................................ 14
EVALUATION FROM UNIT EXECUTIVE OFFICER ......................................................................................... 15
EVALUATION FROM REGIONAL DEAN (IF APPLICABLE .................................................................................. 16
EVALUATION FORM COLLEGE DEAN ............................................................................................................. 17
CV AND SAMPLE PUBLICATIONS..................................................................................................................... 18
2
I.
INFORMATION SUMMARY FORM
EXPEDITED Q CONTRACT
Name:
Department (s):
Present Rank:
Date Awarded:
Proposed Rank:
Proposed Track:
Proposed Tenure Code:
Salaried
or Non-salaried
Academic (RT)
Academic (CT)
Clinical Discipline
Clinical
Research
Adjunct
% salaried for University activities
Degrees (include school, year, name of degree, honors):
Post Doctoral Training (specialty, location, dates):
Board Certification [name(s) of Board(s) and date(s)]:
Professional Positions Held (chronological order with dates):
Anticipated Teaching Responsibilities
%time
What is the quality of teaching? How was the assessment made?
3
Anticipated Service Responsibilities (include patient care, service to
college/university/community)
%time
What is the quality of service? How was the assessment made?
Anticipated Research Activities
%time
Specific Research Field: [identify area(s)]
Total Number of Publications
papers in refereed journals
additional papers
abstracts
books
reviews
other
Current Research Support (list each grant source; PI or Co-I; total direct costs; term)
No. of Previous Grants:
as P.I.
as Co-I.
Sources
Sources
Major Awards, Fellowships, Honors, Societies, National Committees, Editorships, Other:
4
II.
SUMMARY OF COMMITTEE REVIEWS
Candidate: Last Name, First Name & Middle (if applicable)
College: Medicine
Regional Site: Select Regional Site
Unit P&T Committee Review:
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of Members
YES
NO
Name of Chair:
ABSTAIN
ABSENT
Signature:
NOT ELIGIBLE**
Date:
Regional Site or Joint College P&T/Executive Committee Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of Members
YES
NO
Name of Chair:
ABSTAIN
ABSENT
Signature:
NOT ELIGIBLE**
Date:
College P&T Committee Review:
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of Members
YES
NO
Name of Chair:
ABSTAIN
ABSENT
Signature:
NOT ELIGIBLE**
Date:
College Executive Committee P&T Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of Members
Name of Chair:
YES
NO
ABSTAIN
Signature:
ABSENT
NOT ELIGIBLE**
Date:
Voting Justifications
Committee members are considered ineligible 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.
5
III.
STATEMENT OF COLLEGE/UNIT NORMS, EXPECTATIONS, AND STANDARDS OF
EXCELLENCE
COLLEGE NORMS
(NOTE: please insert the information for the appropriate rank/track from the College of Medicine Norms
Statement [http://www.uic.edu/depts/mcam/fa/docs/norms.doc].)
UNIT NORMS
Please insert the information for the appropriate rank/track from the department’s norms statement.
If the unit does not have department-specific norms, indicate that the department follows the College of
Medicine Norms.
6
IV.
Candidate's Personal Statement on Teaching, Research and Service
The candidate should explain his/her activities and philosophical perspectives for teaching, research and
service, assess his/her progress toward those goals, and describe his/her plan for future activities.
(three-page limit recommended)
7
V.
EVALUATIONS
A.
External Letters of Reference
Provide no fewer than three but no more than five letters of reference from full professors of
the relevant discipline who are able to speak with personal knowledge to the candidate's
research, teaching and clinical skills or other service as applicable, as well as his or her
professional stature in the discipline. Letters should be solicited by the department head or a
senior faculty member in the department.
1.
List of Referees Contacted
2.
List of all materials sent to each reviewer.
3.
Insert one copy of letter requesting referee's comments
4.
Referee’s Information and Letter
Provide the information requested for each Referee. Each Letter from a referee should
follow the Referee’s Information Page. Delete any unneeded pages.
8
a. Referee 1
Name of Referee:
Brief Biographical Sketch of Referee:
How was this referee selected?
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.)
**Insert letters from referees on following page(s), numbered as the same page # as this page with “A” next to it
and so on. (e.g. 1A, 1B, 1C).
9
a. Referee 2
Name of Referee:
Brief Biographical Sketch of Referee:
How was this referee selected?
Specify referee's relationship to the Candidate:
**Insert letters from referees on following page(s), numbered as the same page # as this page with “A” next to it
and so on. (e.g. 1A, 1B, 1C)
10
a. Referee 3
Name of Referee:
Brief Biographical Sketch of Referee:
How was this referee selected?
Specify referee's relationship to the Candidate:
**Insert letters from referees on following page(s), numbered as the same page # as this page with “A” next to it
and so on. (e.g. 1A, 1B, 1C)
11
a. Referee 4
Name of Referee:
Brief Biographical Sketch of Referee:
How was this referee selected?
Specify referee's relationship to the Candidate:
**Insert letters from referees on following page(s), numbered as the same page # as this page with “A” next to it
and so on. (e.g. 1A, 1B, 1C)
12
a. Referee 5
Name of Referee:
Brief Biographical Sketch of Referee:
How was this referee selected?
Specify referee's relationship to the Candidate:
**Insert letters from referees on following page(s), numbered as the same page # as this page with “A” next to it
and so on. (e.g. 1A, 1B, 1C)
13
B.
EVALUATION FROM DEPARTMENAL P&T COMMITTEE
(Letter optional; report of vote by committee in Section II is required)
14
C.
EVALUATION FROM UNIT EXECUTIVE OFFICER
Candidate:
Date:
College:
Department:
Unit Executive Officer/Equivalent is also the Paper Preparer:
YES
NO
JUSTIFICATION FOR RECOMMENDATION
(should include appraisal of candidate’s teaching record, research and scholarship, service record,
and provide an overall assessment and justification for recommendation)
Unit Executive Officer
Unit Executive Officer (signature)
(Place name and signature on the last page only)
15
D.
EVALUATION FROM REGIONAL DEAN (if applicable
Candidate:
Date:
College: Medicine
Department:
I support the proposed personnel action for the reasons detailed below.
I do not support the proposed personnel action for the reasons detailed below
JUSTIFICATION FOR RECOMMENDATION
(Evaluation must address split votes at the college/college executive level)
Regional Dean's Name
Regional Dean
Regional Dean (signature)
(Place name and signature on the last page only)
16
E.
EVALUATION FORM COLLEGE DEAN
Candidate:
Date:
College: Medicine
Department:
I support the proposed personnel action for the reasons detailed below.
I do not support the proposed personnel action for the reasons detailed below
JUSTIFICATION FOR RECOMMENDATION
Dimitri Azar, MD
College Dean
College Dean (signature)
(Place name and signature on the last page only)
17
F.
CV AND SAMPLE PUBLICATIONS
Attach candidate’s current CV and 3 sample publications following this page.
Note: CV must include information on teaching, service and research activities, including
details on sponsored research.
18