Annual Faculty Review TEMPLATE (Optional Format)

(please copy and paste into your personal letterhead)

Department:

Department Chair:

Review Date:

Faculty member should complete and provide information requested on this page of the form to his/her department chair along with an updated CV (highlighting or underlying activities from the past 12 months). Please submit 1 week prior to the scheduled meeting.

Faculty Member Name:

Current Academic Rank:

Years in Current Academic Rank:

Annual Self Evaluation (completed by faculty member):

1. Please describe your progress and achievements for the past year, including scientific progress that is not yet published.

2. What are your goals and plans for the coming year?

3. What are your long-term scientific and career goals?

4. What can the department do to help you achieve these goals?

5. Please also come prepared to talk about anything that you believe may be relevant to your career progress. No written material is required for this element. Some possible topics include questions, challenges and/or needs related to:

· Your various roles in academia (e.g. scientist, teacher…)

· The mentoring you are receiving from faculty in your department

· Your recruitment and/or supervision of trainees

· Your work-life balance

· Any other concerns that you feel are impacting your career and that you would like to discuss privately

At the conference, the Department Chair should fill out this page of the form with the faculty member:

Please provide a brief summary of your discussion with the faculty member, including expectations and goals for career advancement and promotion. Please describe action steps for mutually agreed upon goals:

______

Both the faculty member and the Department Chair should sign and date below

Signed: ______

Department Chair Date

______

Faculty Member Date

Updated July 2016

Managed by the Office for Faculty Affairs

Harvard Medical School | Gordon Hall, Suite 206 | 25 Shattuck Street, Boston, Massachusetts 02115