Your Name
1. Date:
I Personal
2. Name:
3. Home Phone:
4. Office Phone:
5. Home Address:
6. Current Academic Rank: [i.e. Instructor, Assistant Prof, Associate Prof or Professor]
[SOM notes]
6a. Current Track of Appointment: [i.e. Tenure-earning track, Clinical Educator track, Research Track, Adjunct track, Affiliated track or Voluntary Track.
note – the Rank of Instructor does not carry a track designation]
7. Primary Department:
8. Secondary or Joint Appointments:
9. Citizenship:
10. Visa Type (if non-citizen):
II. Higher Education
11. Institutional (institution; degree; date conferred):
12. Non-Institutional (description; dates):
13. Certification, licensure (description; board or agency; dates):
III. Experience
14. Academic (institutions; rank/status; dates): [dates should be inclusive for each entry – i.e. 1991-95)
15. Hospital Appointments (institutions, dates)
16. Non-Academic (employers; title; responsibilities; dates) [dates should be inclusive]
17. Military (branch; rank; responsibilities; dates) [dates should be inclusive]
IV. Publications
[start publications on a separate page]:
[authors (in actual precedence of authorship); title; publisher or journal name; page numbers; date (current year first) ]
[SOM notes]
a). In all sections that follow, page numbers must be inclusive so that, for example, a full report is not mistaken for an abstract or preliminary communication
b). Publications in each section should be listed in reverse chronological order
c). Publications should be listed as ‘in press’ only if there is a letter from the editor specifically defining that the article (book) has been accepted and that this acceptance is not contingent upon approval of revisions. Such letters must be included in the file of a candidate being considered by the School of Medicine for promotion and/or tenure.
d). Do notlist publications that are ‘in preparation.’
18. Books and monographs published:
[SOM notes]
a). include book chapters here
b). for each book chapter, include the authors, title of chapter and inclusive pages. Also include the book title, publisher, date and book authors/editors
c). example of a book chapter entry:
Jones, AB and CD Smith, Cardiovascular Physiology, In: Essentials of Physiology, HG Wells ed., Plenum Press, 121-142, 1997
19. Juried or refereed journal articles or exhibitions:
[SOM notes]
a). List only full articles refereed for peer-reviewed publications. Do not list juried abstracts or presentations at national meetings here.
b). Do not list juried posters or other presentations as exhibitions unless these result in a permanently created body of work
c). List juried articles that are ‘in press’ in this section
d). Example of a journal listing:
Smith, R.A., C.J. Jones, Q.X. James and M.T. Doe, Surgical Complications of Astrocytomas, Journal of Theoretical Surgery, 16:242-283, 1996
20. Other works, publications and abstracts:
[SOM notes]
a). for example, letters to the editor, magazine and newspaper articles
b). clearly denote whether abstracts were voluntary or refereed
21. Other works accepted for publication:
V. Professional
22. Funded Research Performed (include all grants received in the last five years, identifying the principal investigator, and the amounts and dates of the awards):
[SOM notes]
a). list the titles and funding agency (with grant number) for each grant. Clearly note whether your grant is part of a Center or other overall program
b). identify the principal investigator – and also define your role in each program and your percent of funded effort in the grant program
c). identify the direct, indirect and total amounts of each award with inclusive dates
23. Editorial responsibilities [with inclusive dates]:
24. Professional and Honorary Organizations (member; officer; date): [inclusive dates]
25. Honors and Awards [with dates]
26. Post-Doctoral Fellowships:
27. Other Professional Activities (e.g. papers presented; performances; conference proceedings; seminar or conference panel member; catalogue work; etc):
VI. Teaching
28. Teaching Awards Received:
[SOM notes]
a). describe award and its source
b). describe the approximate pool from which you were selected to receive this award
c). describe how the award choice was made and who made this choice
29. Teaching Specialization (courses taught):
[SOM notes]
a). include a description of your participation in courses that were taught
b). include a description of any other professional teaching activities
30. Thesis and Dissertation Advising/Post-doctoral student supervision (chairman or committee member; topic; student name; date)
VII. Service
31. University Committee and Administrative Responsibilities [with inclusive dates]
32. Community Activities [with inclusive dates]