For Instructors with the CHA Program

Application for Affiliate Faculty Appointment

College of Rural and Community Development, University of AlaskaFairbanks

Instructions

These instructions are intended to assist individuals employed in CHAP programs as an instructor interested in obtaining affiliate clinical faculty status within the College of Ruraland Community Development (CRCD), University of Alaska Fairbanks (UAF).

These steps will be followed:

1.Applicant requests affiliate faculty appointment.

2.Application form, current CV (including names of two references), and copy of licensure are sent to UAF CHAP Program’s Anchorage office for review and approval (address on otherside).

3.Official letter of appointment is written, sent to CRCD Vice Chancellor for review and signature.

4.Letter of appointment is mailed to UAF CHAP academic liaison in Anchorage, who establishes or updates a file for the affiliate faculty member and mails the letter of appointment to the affiliate faculty member for signature.

5.The original letter of appointment is signed and mailed to the UAF CHAP Program’s Anchorage office (affiliate faculty retains a copy).

Affiliate clinical faculty appointments will be made considering professional credentials as the required terminal degree:

AppointmentCredential Requirements

CHP/RN/otherNP/PA/MD

Clinical Instructor...... X

Clinical Assistant Professor...... X

Approval Means:

Clinical Instructor: can sign as instructor of record all catalog CHP courses except "basic training" courses (CHP 131 through 135 series, see Review and Approval Committee Standards).

Clinical Assistant Professor: can sign as instructor of record for all catalog and special topics CHP courses.

Affiliate Faculty responsibilities:

1. Participate in student advising for the UAF Community Health Certificate and Associate of Applied

Science Degree.

2. Network with other faculty.

3. Keep current on University policies and procedures relating to the CHAP program to provide

accuratestudent advising.

4. Participate in academic review processes relating to CHP courses.

Affiliate Clinical Faculty appointments continue with ongoing employment within the CHAP program with
letters renewed every three years.

11/93 Updated 2/13(Application form on back)

College of Rural and Community Development

University of AlaskaFairbanks

Application for Affiliate Faculty Appointment

For Instructors with the CHA Program

This application provides an opportunity for individuals employed by Community Health Aide Programs as an instructor to request Affiliate Faculty appointment at the University of Alaska Fairbanks. Applications may be submitted at anytime. Appointments are issued October 1 and March 1 of each year.

Please mail this application, your CV (including names of two references), and copy of licensure to:

Linda Curda, CHAP Academic Liaison

2221 E. Northern Lights Blvd, Suite 109

UAF CRCD Health Programs

Anchorage, AK99508-4140

(907) 786-1630 (FAX 907-786-1657)

PLEASE PRINT CLEARLY

Name:______Job Title: ______

Address: ______

Social Security Number: ____ - ___ - ______Phone:______

Email Address: ______

Employer: ______

______

Applicant SignatureDate

------

(UAF CRCD use only)

The above named applicant is approved for Affiliate Faculty appointment to the UAF College of Rural and Community Development Health Programs as (please check one):

_____ Clinical Instructor

_____ Clinical Assistant Professor

______

UAF CHAP Academic LiaisonDate

11/93 Updated 2/13(Instructions on back)