NON-SALARIED CLINICAL AND ADJUNCT NON-TENURE TRACKS
PROMOTION FORMS – ACADEMIC YEAR 2015-16
*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
Select Unit Type: Unit Name
%FTE: %FTE%
Joint Appointment College: Select Joint College (if applicable)
Regional Site: Select Regional Site
Select Joint Unit Type: Joint Unit Name
%FTE: %FTE%
Courtesy Appt. (0%FTE/UNPAID): Select Courtesy Appt. College
Select Courtesy Unit Type: Courtesy Unit Name(s)
Present Personnel Appointment:
Rank: Select Rank
Joint Appointment Rank: Joint Appointment Rank
Tenure Code: Select Code
Joint Tenure Code: Select Joint Code
Appointed or Promoted to Present Rank: Select Month – Year
Tenure Code Legend:
N = Non-Tenure Track
M = Multi-Year Contract
W = W-Contract
Courtesy Rank (if applicable): Select Courtesy Rank
Proposed Personnel Action:
Rank: Select Rank
Joint Rank: Joint Appointment Rank
Tenure Code: Select Code
Joint Tenure Code: Select Joint Code
I have read the Promotion and Tenure Policies and Procedures:
Faculty Candidate:
Last, First Name & Middle (if applicable)
Name (Print)
Signature
Date
Signature
Date
Papers Prepared by: Last, First Name
Name (Print)
Paper Preparer is also the Unit Executive Officer/Equivalent:
ENDORSEMENT
NON-ENDORSEMENT
YES
NO
(COMPLETE FOR APPLICABLE REVIEW LEVELS)
Type Name
Unit Executive Officer (UEO)/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
Date
Type Name
Joint Dean Name and Signature (if applicable)
Date
Final Disposition in Office of the Vice Chancellor for Academic Affairs and Provost:
ENDORSEMENT
NON-ENDORSEMENT
____________
_____________
__________________________________________________
Vice Chancellor for Academic Affairs and Provost
1
Date
Table of Contents for Materials Contained in the Dossier
COVER SHEET ..................................................................................................................................................................... 1
ACADEMIC AND EMPLOYMENT INFORMATION ..................................................................................................... 4
1.
2.
3.
4.
5.
NATURE OF PRESENT APPOINTMENT .......................................................................................................................... 4
EDUCATION ................................................................................................................................................................ 4
POST-DOCTORAL INFORMATION ................................................................................................................................. 4
LICENSING AND/OR CERTIFICATIONS .......................................................................................................................... 4
ACADEMIC & PROFESSIONAL POSITIONS SINCE TERMINAL DEGREE AND POST-DOCTORAL TRAINING...................... 5
SUMMARY OF COMMITTEE REVIEWS ........................................................................................................................ 6
VOTING JUSTIFICATIONS ............................................................................................................................................... 6
STATEMENT OF COLLEGE NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE ...................... 7
STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE ................................ 7
DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE
TRACK FACULTY ........................................................................................................................................................ 8
I.
TEACHING ABILITY AND PERFORMANCE ......................................................................................................... 9
A.
B.
C.
D.
LECTURES AND SEMINARS ................................................................................................................................. 9
SMALL GROUP TEACHING ................................................................................................................................. 11
CLINICAL TEACHING .......................................................................................................................................... 13
OTHER TEACHING ACTIVITIES AND CURRICULAR DEVELOPMENT ....................................................... 15
1. Other Teaching Activities ................................................................................................................................. 15
2. Curricular Development ................................................................................................................................... 15
E. SUMMARY OF STUDENT EVALUATION OF FACULTY TEACHING ........................................................... 16
F. FORMAL RECOGNITION OF TEACHING ABILITY ......................................................................................... 16
G. CANDIDATE’S STATEMENT ON TEACHING GOALS, APPROACHES AND, ACCOMPLISHMENTS ....... 17
H. OTHER SIGNIFICANT TEACHING RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR
PERIOD ................................................................................................................................................................... 17
II. PATIENT CARE ACTIVITIES .................................................................................................................................. 18
A. SPECIALTY/SUBSPECIALTY .............................................................................................................................. 18
B. BOARD CERTIFICATION [NAME OF BOARD(S) AND DATE(S)]................................................................... 18
C. HOSPITAL PRIVILEGES (CURRENT) ................................................................................................................. 18
III. SCHOLARLY ACTIVITIES ....................................................................................................................................... 19
A. AREA(S) OF SCHOLARLY INTEREST ................................................................................................................ 19
B. PEER RECOGNITION FOR SCHOLARLY ACTIVITIES .................................................................................... 19
C. PUBLICATIONS OR OTHER CREATIVE WORK RELEVANT TO THE DISCIPLINE .................................... 19
IV. SERVICE ACTIVITIES............................................................................................................................................... 21
A. SERVICE TO THE COLLEGE OF MEDICINE OR UIC ....................................................................................... 21
B. SERVICE TO THE PROFESSION/DISCIPLINE ................................................................................................... 21
V. EVALUATIONS ........................................................................................................................................................... 22
A. LETTERS FROM FORMER STUDENTS/RESIDENTS/FELLOWS .................................................................... 22
B. LETTERS OF RECOMMENDATION FOR SALARIED (1-50%) CLINICAL AND ADJUNCT
APPOINTMENTS AND PROMOTIONS ............................................................................................................... 23
1. List of Referees Contacted ................................................................................................................................ 23
2. Copy of Letter(s) of Request for Referee’s Comments ...................................................................................... 23
3. List of all Materials Sent to Each Reviewer ...................................................................................................... 23
4. Referee’s Information ....................................................................................................................................... 24
C. LETTERS FROM COLLABORATORS SOLICITED BY THE U.E.O. ................................................................. 29
D. LETTER(S) FOR COURTESY APPOINTMENT(S) .............................................................................................. 30
E. EVALUATION FROM DEPARTMENTAL COMMITTEE .................................................................................. 31
2
F. EVALUATION FROM COLLEGE P&T COMMITTEE ........................................................................................ 32
G. EVALUATION FROM COLLEGE’S PROCESS FOR REVIEW OF CLINICAL NON-TENURE TRACK
FACULTY ............................................................................................................................................................... 33
H. EVALUATION FROM UNIT EXECUTIVE OFFICER / EQUIVALENT ............................................................. 34
I. EVALUATION FROM DEAN ................................................................................................................................ 35
1. Evaluation from Regional Dean (if applicable) ................................................................................................ 35
2. Evaluation from College Dean ......................................................................................................................... 36
3
ACADEMIC AND EMPLOYMENT INFORMATION
1. Nature of Present Appointment
a.
Percentage of time (total UIC employment):
b.
100%
Optional - Official distribution of effort:
Teaching (include clinical):
%
Research:
%
Student/Resident Services:
%
Patient Care:
%
Public Service:
%
Administration:
%
Other:
%
(specify)
2. Education
a.
Highest degree:
b.
Year awarded:
c.
Institution:
d.
Department:
e.
Dissertation/thesis title:
f.
Thesis Advisor Name:
3. Post-Doctoral Information
(Clinicians should include residency/fellow training.)
a.
List Post-Doctoral appointments:
b.
Name of Post-doctoral Advisor (if applicable):
4. Licensing and/or Certifications
Provide a list of all professional licensing and/or certifications with dates.
(If pending, give expected date of completion.)
1)
2)
3)
4)
5)
4
Other
%
5. Academic & Professional Positions Since Terminal Degree and Post-Doctoral Training
List 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), numbered as 5a, 5b, 5c and so on.
#
Dates
Rank/Title
Institution/Organization
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
5
SUMMARY OF COMMITTEE REVIEWS
Candidate: Last Name, First Name & Middle (if applicable)
College: Select College for Primary Appointment
Regional Site: Select Regional Site
Joint Appt. College: Select Joint College
Unit(s): For Joint Appts. List All Units with (%FTE) Next to each Unit
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:
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
Name of Chair:
ABSTAIN
ABSENT
Signature:
NOT ELIGIBLE**
Date:
Regional or Joint College P&T 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
YES
NO
Name of Chair:
ABSTAIN
ABSENT
Signature:
NOT ELIGIBLE**
Date:
Campus P&T Committee Review:
* 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.
Additional Voting Justifications, if needed, should be inserted in the PDF, numbered as the same page # with “A” (e.g. 1A, 1B).
6
STATEMENT OF COLLEGE NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
(NOTE: please insert the appropriate information from the College of Medicine Norms Statement
[http://www.uic.edu/depts/mcam/fa/docs/norms.doc]).
STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
Please insert the information for the appropriate rank/track from the department’s norms statement.
If the unit does not have department-specific norms, please indicate that the department follows the College of
Medicine Norms.
7
DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE
TRACK FACULTY
Faculty in the College of Medicine’s Clinical and Adjunct Track (0 – 50% FTE) are reviewed by the College
Committee on Clinical and Adjunct Appointments and Promotions and by the College Executive Committee.
**If the department has a process, include it below or as separate page(s) numbered as the same page #
as this page with “A” next to it and so on.] (e.g. 1A, 1B, 1C).
8
I.
TEACHING ABILITY AND PERFORMANCE
A. LECTURES AND SEMINARS
Identify the candidate’s specific lecture and/or seminar teaching activities over the past five years.
This sheet can be reproduced as many times as necessary to reflect all of the candidate’s activities.
Check here if none
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
9
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Lectures/Seminars
Lecture/Seminar Title:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
10
B. SMALL GROUP TEACHING
Identify the candidate’s specific small group teaching activities over the past five years. This
sheet can be reproduced as many times as necessary to reflect all of the candidate’s activities.
Check here if none
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
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Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Small Group Teaching
Subject Topic:
Course Title:
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
12
C. CLINICAL TEACHING
Identify the candidate’s specific small group teaching activities over the past five years. This
sheet can be reproduced as many times as necessary to reflect all of the candidate’s activities.
Check here if none
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
13
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
Clinical Teaching/Attending
Specific Teaching Activity:
Level of Students/Trainees:
Number of Students/Trainees per Session:
Length of Rotation:
Date(s) Given:
14
D. OTHER TEACHING ACTIVITIES AND CURRICULAR DEVELOPMENT
Identify other types of teaching activities done by the candidate over the past five years. This
sheet can be reproduced as many times as necessary to reflect all of the candidate’s activities.
1. Other Teaching Activities
Check here if none
Other: (Specify):
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Other: (Specify):
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Other: (Specify):
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
Other: (Specify):
Level of Students/Trainees:
Average Number of Students/Trainees per Session:
Date(s) Given:
2. Curricular Development
Describe the candidate’s role in any curricular development or teaching innovation over the
past five years.
Check here if none
15
E. SUMMARY OF STUDENT EVALUATION OF FACULTY TEACHING
Summarize the results of student evaluations of the candidate’s overall teaching effectiveness for
each teaching activity. If narrative comments from student evaluations are included, all comments
from all students in that course should be included. If an assessment scale is used, identify the
scale (i.e. candidate evaluated on a scale of 1 to 5 where 5=excellent).
Check here if none
F. FORMAL RECOGNITION OF TEACHING ABILITY
Please indicate nature of and criteria for recognition as well as the dates of awards.
Check here if none
16
G. CANDIDATE’S STATEMENT ON TEACHING GOALS, APPROACHES AND, ACCOMPLISHMENTS
The 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 numbered
as the same page # as this page with “A” next to it and so on. (e.g. 1A, 1B, 1C), or typed below).
H. OTHER SIGNIFICANT TEACHING RECOGNITION/ACHIEVEMENT NOT COVERED IN THE
FIVE-YEAR PERIOD
(Post-doctoral data may not be included.)
Check here if none
17
II. PATIENT CARE ACTIVITIES
A. SPECIALTY/SUBSPECIALTY
Check here if none
B. BOARD CERTIFICATION [NAME OF BOARD(S) AND DATE(S)]
Check here if none
C. HOSPITAL PRIVILEGES (CURRENT)
Check here if none
Description of the participation of the trainees in the candidate’s clinical practice. (Include type of practice,
patient population, referral base, and special emphases or other distinguishing features.)
Check here if none
18
III. SCHOLARLY ACTIVITIES
A. AREA(S) OF SCHOLARLY INTEREST
Check here if none
B. PEER RECOGNITION FOR SCHOLARLY ACTIVITIES
(e.g. funding awards, invitations to speak or present, service on advisory committees, etc.)
Check here if none
C. PUBLICATIONS OR OTHER CREATIVE WORK RELEVANT TO THE DISCIPLINE
List in chronological order. 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
Check here if none
b.
Edited volumes and translations
Check here if none
c.
Articles in refereed journals
(Do not abbreviate titles; give inclusive page numbers.)
Check here if none
d.
Other articles, including bulletins and technical reports
(Give inclusive page numbers.)
Check here if none
e.
Chapters in books
(Give inclusive page numbers.)
Check here if none
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f.
Book reviews
(Give inclusive page numbers.)
Check here if none
g.
Creative works
(e.g., poetry, composition, exhibitions)
Check here if none
h.
Patents
Check here if none
i.
Other
(e.g., notes and comments)
Check here if none
20
IV. SERVICE ACTIVITIES
A. SERVICE TO THE COLLEGE OF MEDICINE OR UIC
Identify specific service to the College of Medicine or UIC over the past five years. Also include
memberships on departmental, site, College and University committees.
Check here if none
B. SERVICE TO THE PROFESSION/DISCIPLINE
Identify specific service to the profession/discipline over the past five years. Include
memberships on advisory committees for or consultantships to hospitals and educational, clinical,
or other similar institutions.
Check here if none
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V. EVALUATIONS
A. LETTERS FROM FORMER STUDENTS/RESIDENTS/FELLOWS
Letters from former students/residents/fellows or others supervised by the candidate may be
appropriate to assist in appraising the candidate’s clinical teaching.
Enter below a list of persons from whom such assessment was requested. All replies to this
request must be included.
Check here if none
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B. LETTERS OF RECOMMENDATION FOR NON-SALARIED CLINICAL AND ADJUNCT
APPOINTMENTS AND PROMOTIONS
Letters of reference should be solicited from not fewer than three but no more than five referees.
Letters may be solicited from individuals with a direct knowledge of the candidate's teaching
performance, quality of patient care and professional reputation. Referees should be at or above
the academic rank for which the candidate is being proposed, and may be non-tenured. Letters
from individuals who have a real or apparent conflict of interest in advocating the candidate (i.e.
financial partners, subordinates or anyone who could directly benefit from the candidate’s
promotion) are not appropriate.
All replies to requests for an evaluation of the candidate that were received by the department 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 Contacted
a. Those Who Accepted
b. Those Who Declined
c.
Those Who Did Not Respond
2. Copy of Letter(s) of Request for Referee’s Comments
Insert one copy of letter requesting referee's comments, including one copy (if applicable) of
all communications inquiring whether the referee is willing to serve.
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).
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4. Referee’s Information
Provide 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 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).
24
a. Referee 2
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).
25
a. Referee 3
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).
26
a. Referee 4
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).
27
a. Referee 5
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).
28
C. LETTERS FROM COLLABORATORS SOLICITED BY THE U.E.O.
(IF APPLICABLE)
Unit executive officer(s)/Equivalent must solicit letters from individuals who have had a substantial
collaboration with the candidate. Letters from those individuals should document the contributions
of the candidate to the joint work.
**Insert letters from collaborators 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)
29
D. LETTER(S) FOR COURTESY APPOINTMENT(S)
(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), numbers as the same page # as this page with “A” next to it
and so on. (e.g. 1A, 1B, 1C).
30
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), numbered as the same
page # as this page with “A” next to it and so on. (e.g. 1A, 1B, 1C).
31
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), numbered as the same page #
as this page with “A” next to it and so on. (e.g. 1A, 1B, 1C).
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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), numbered as the same page # as this page with “A”
next to it and so on. (e.g. 1A, 1B, 1C).
Faculty in the College of Medicine’s Clinical and Adjunct Track (0 – 50% FTE) are reviewed by the
College Committee on Clinical and Adjunct Appointments and Promotions and by the College
Executive Committee.
Check here if not applicable.
33
H. EVALUATION FROM UNIT EXECUTIVE OFFICER / EQUIVALENT
Candidate:
Date:
College: Medicine
Department:
Unit Executive Officer/Equivalent is also the Paper Preparer:
YES
NO
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 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.)
2. Appraisal of Candidate’s Contribution to Curriculum and Other Instructional Materials or Products
(Describe and assess the candidate's contributions to curriculum.)
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.)
4. Appraisal of Candidate’s Service Record
(Justify this assessment and attach any supporting documents.)
5. Overall Assessment and Justification for Recommendation
U.E.O. Name
Unit Executive Officer
Unit Executive Officer (signature)
(Place name and signature on the last page only)
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I.
EVALUATION FROM DEAN
1. Evaluation from Regional Dean (if applicable)
Check here if not 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)
35
2. Evaluation from 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
(Evaluation must address split votes at the college/college executive level)
Dimitri Azar, MD
College Dean
College Dean (signature)
(Place name and signature on the last page only)
36