Long Forms and Handbook Forms
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University Long Forms
Use these forms for all faculty appointment, reappointment, and promotion recommendations (all ranks and lines). Check carefully to be sure you have downloaded the correct form for your recommendation.
- University long forms (you'll also need the matching School of Medicine evidence table - see below.)
School of Medicine Evidence Tables
The new University forms defer to the Schools in many cases regarding the type and amount of evidence required. Please download and review carefully the appropriate School of Medicine-specific evidence table for your recommendation. Use these tables in place of the evidence tables in the University long forms.
- Evidence - Form B1 (new untenured fixed-term appointment)
- Evidence - Form B2 (fixed-term reappointment or promotion)
- Evidence - Form B3 (reappt/promo conferring tenure or continuing term)
- Evidence - Form B4 (promotion - already has tenure or continuing term)
- Evidence - Form B5 (new appointment to tenure or continuing term)
Clinical Excellence Core Competencies Evaluation
- Eval Info and FAQs
- Instructions
- Form (Word)
- Form (PDF)
- Summary Reporting Template
- Informal Tracking Worksheet (with thanks to Pediatrics)
Other Forms
Professoriate (UTL, NTL, MCL)
- Applicant Pool Information (formerly "Affirmative Action Aspects of Faculty Search Grid") - click this link, then scroll down to bottom of page.
- Annual Certification of Compliance to the Faculty Policy on Conflict of Commitment and Interest ("Conflict of Interest form")
- OLD Evaluation of Clinical Excellence (replaced by new form - see above. Do not use this form after 8-19-09)
- Professional Services Income Agreement ("PSI")
- Recommendation for Amendment of Professorial Appointment ("Blue Form")
- Referee Grid (for faculty referee solicitations)
- New Parent Appointment Extension Application
- Annual Career Planning Conference Form
Other Teaching Titles (Clinician/Educators, Instructors, ACF, Short-Term Faculty)
- Recommendation For Appointment: Academic & Other Teaching Staff and Appointments (By courtesy) ("Green Form")
- Recommendation For Appointment: Streamlined Appointment and Reappointment of Adjunct Clinical Instructors and Clinical Instructors (Affiliated) -- one year only ("Yellow Form")
- Application for Visiting Scholar Status
Professorial Sabbatical and Leave
Miscellaneous
- Acknowledgment of Abuse Reporting
Provisions of California Penal Code
- New! Employment Eligibility Verification (INS Form I-9) Available at http://www.uscis.gov/files/form/I-9_IFR_02-02-09.pdf. The USCIS has also released a new Employer Handbook for the I-9 process. The Handbook contains instructions for completing the I-9 Form, sample images of the acceptable documents and FAQs. The Handbook is available from http://www.uscis.gov/files/nativedocuments/m-274_3apr09.pdf
- Source of Salary Support
- Staff Physician Reappointment
Form
- Staff Physician
Business Plan
(for Explorer users)
- Staff Physician Business Plan (zip file for Netscape users; please visit http://www.winzip.com/ for unzip utilities.)
- Staff Physician
Business Plan Category Explanations
- Licensure Form
- Recommendation
for Appointment/Promotion of Academic Staff-Research
