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CLINICAL NON-TENURE TRACK
PROMOTION FORMS – ACADEMIC YEAR 2018-19
*CANDIDATE’S PERSONNEL & APPOINTMENT INFORMATION MUST BE ENTERED AS LISTED IN BANNER/HR FRONT END*
Candidate: Last Name, First Name & Middle (if applicable)UIN #: UIN #
College: Select College for Primary Appointment
Select Unit Type: Unit Name%FTE: %FTE %
Joint Appointment College: Select Joint College (if applicable)
Select Joint Unit Type: ASDFASDF%FTE: %FTE%
Courtesy Appt. (0%FTE/UNPAID): Select Courtesy Appt. CollegeSelect Unit Type: Unit Name(s)
Present Personnel Appointment:
Rank: Select RankJoint Rank: Select Joint Rank
Tenure Code: Select Code Joint Tenure Code: Select Joint Code
Appointed or Promoted to Present Rank: Select Month – Year
Courtesy Rank (if applicable): Select Courtesy Rank
Proposed Personnel Action:
Rank: Select RankJoint Rank: Select Joint Rank
Tenure Code: Select Code Joint Tenure Code: Select Joint Code
Faculty Candidate Attestation:
To the best of my knowledge, the information to which I have access that is provided in this dossier (i.e., non-confidential components) is true and accurate.
I do not have a conflict of interest or a dual relationship with the Paper Preparer, as defined by Section 2.F.3 (Voting and Dual Relationships) and Section 3.D (Responsibility for the Case) of the Clinical Non-Tenure System Promotion and Tenure Guidelines, Part I: Campus Policies and Procedures.
Faculty Candidate: Last, First Name & Middle (if applicable)
Name (Print)SignatureDate
Paper Preparer Attestation:
To the best of my knowledge, the information to which I have access that is provided in this dossier (i.e., non-confidential components) is true and accurate.
I do not have a conflict of interest or a dual relationship with the Candidate, as defined by Section 2.F.3 (Voting and Dual Relationships) and Section 3.D (Responsibility for the Case) of the Clinical Non-Tenure System Promotion and Tenure Guidelines, Part I: Campus Policies and Procedures.
Paper Preparer: Last, First Name
Name (Print)SignatureDate
Paper Preparer is also the Unit Executive Officer/Equivalent: YES NO
ENDORSEMENTS: UNIT, COLLEGE, AND CAMPUS
Candidate: Last Name, First Name & Middle (if applicable)
ENDORSEMENTNON-ENDORSEMENT(COMPLETE FOR APPLICABLE REVIEW LEVELS)
Type Name
Unit Executive Officer (U.E.O.)/Equivalent Name/SignatureDate
Type Name
Joint U.E.O./Equivalent Name /Signature (if applicable)Date
Type Name
Regional Dean Name and Signature (if applicable) Date
Type Name
College Dean or Unit Director Name and SignatureDate
Type Name
Joint Dean Name and Signature (if applicable)Date
ENDORSEMENTNON-ENDORSEMENT
______
Provost and Vice Chancellor for Academic Affairs Date
ENDORSEMENTNON-ENDORSEMENT
______
Vice Chancellor for Health AffairsDate
Table of Contents for Materials Contained in the Dossier
cover Page...... 1
ENDORSEMENT PAGE………………………………………………………...... 2
Table of Contents for Materials Contained in the Dossier
ACADEMIC AND EMPLOYMENT INFORMATION
1.Nature of Present Appointment
2.Education
3.Post-Doctoral Information
4.Licensing and/or Certifications
5.Academic & Professional Positions Since Terminal Degree and Post-Doctoral Training
SUMMARY OF COMMITTEE REVIEWS
Voting Justifications
STATEMENT OF COLLEGE NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE TRACK FACULTY
I. TEACHING ABILITY AND PERFORMANCE
A. ACTIVITIES
1. Courses Taught
2. Graduate Students
2.a. Graduate Student Advising and Supervision.
2.b. Graduate Student Exam Committee
3. Undergraduate Advising and Supervision:
4. Residents and Post-Doctoral Fellows Supervised.
5. Direction of Research Associates, Visiting Scholars, and Technicians.
6. Contributions to Instructional Techniques, Software and Teaching Materials:
7. Other Teaching Activities External to UIC:
8. Other Significant Teaching Recognition/Achievement not Covered in the Five-Year Period
B. EVALUATION OF TEACHING AND RELATED ACTIVITIES
1. Summary of Student Evaluations of Faculty Teaching.*
2. Formal Recognition of Distinction in Teaching.
3. Candidate's Statement on Teaching Goals, Approaches and Accomplishments
II. RESEARCH/SCHOLARSHIP ABILITY AND ACHIEVEMENT
A. HONORS AND AWARDS ETC SINCE RECEIVING TERMINAL DEGREE
B. INVITED COLLOQUIA AND SYMPOSIA
C. OTHER INVITED PRESENTATIONS (e.g., LECTURES, WORKSHOPS, etc.)
D. OTHER EVIDENCE OF RECOGNITION
E. LICENSING/CERTIFICATION SINCE RECEIVING TERMINAL DEGREE
F. SPONSORED RESEARCH ACTIVITIES
G. PUBLICATIONS, PAPERS, AND OTHER SCIENTIFIC, CREATIVE OR SCHOLARLYWORKS
1. Publications or Other Creative Work Relevant to the Discipline (BEFORE)
2. Publications or Other Creative Work Relevant to the Discipline (SINCE)
3. Work Completed and Accepted for Publication.
4. Work in Progress
5. Papers and Poster Sessions Presented at Professional Meetings
6. Other Scientific Contributions, Creative or Scholarly Works
H. OTHER SIGNIFICANT RESEARCH/SCHOLARSHIP RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD
I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED RESEARCH, CREATIVE OR SCHOLARLY WORK
III. SERVICE
A. ADMINISTRATIVE RESPONSIBILITIES
B. SERVICE TO THE DEPARTMENT/COLLEGE
C. SERVICE TO THE UNIVERSITY
D. SERVICE RELATED TO PATIENT CARE
E. SERVICE RELATED TO STUDENTS
F. SERVICE TO THE PROFESSION/DISCIPLINE
G. PUBLIC SERVICE
H. OTHER SIGNIFICANT SERVICE RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD
I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED SERVICE ACTIVITIES
IV. CANDIDATE'S STATEMENT OF INTERDISCIPLINARY WORK - OPTIONAL
V. EVALUATIONS
A. PEER EVALUATION OF FACULTY TEACHING
Statement of Unit’s Policy for the Evaluation of Teaching
B. EXTERNAL LETTERS OF REFERENCE
1. List of Referees Contacted
2. Copy of Letter(s) of Request for Referee’s Comments
3. List of all Materials Sent to Each Reviewer.
4. Referee’s Information
C. LETTERS OF SUPPORT SOLICITED BY THE U.E.O./PAPER PREPARER (with input from the candidate)
D. LETTER(S) FOR COURTESY APPOINTMENT(S) (IF APPLICABLE)
E. EVALUATION FROM DEPARTMENTAL COMMITTEE
F. EVALUATION FROM COLLEGE P&T COMMITTEE
G. EVALUATION FROM COLLEGE’S PROCESS FOR REVIEW OF CLINICAL NON-TENURE TRACK FACULTY
H. EVALUATION FROM UNIT EXECUTIVE OFFICER / EQUIVALENT
I. EVALUATION FROM COLLEGE DEAN
ACADEMIC AND EMPLOYMENT INFORMATION
1.Nature of Present Appointment
a.Percentage of time (total UIC employment): 100% Other %
2.Education
a. Highest degree:
b. Year awarded:
c.Institution:
d. Department:
e.Dissertation/thesis title:
f.Thesis Advisor Name:
3.Post-Doctoral Information
a.List Post-Doctoral appointments:
b. Name of Post-doctoral Advisor:
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)
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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). It is not necessary to add page numbers in this section.
# / Dates / Rank/Title / Institution/Organization1
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SUMMARY OF COMMITTEE REVIEWS
Candidate: Last Name, First Name & Middle (if applicable)
College: Select College for Primary AppointmentRegional 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 MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Joint Unit P&T Committee Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Joint College or Regional Site P&T Committee Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
College P&T Committee Review:
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
College Executive Committee P&T Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Campus P&T Committee Review:
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Voting Justifications
**Include brief explanation(s) as to why members were “Not Eligible” (NE) to vote for each level and/or include Voting Justifications if needed, as inserted page(s) in the PDF. It is not necessary to add page numbers in this section.
STATEMENT OF COLLEGENORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
**Include Statements for all Ranks within the Clinical Non-Tenure Track
(Include as separate page(s). It is not necessary to add page numbers in this section.)
STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
**Include Statements for all Ranks within the Clinical Non-Tenure Track
(Include as separate page(s).It is not necessary to add page numbers in this section.)
DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE TRACK FACULTY
**If the college has a process, include it. If not, indicate that the college does not have a separate process. The process for peer evaluation may be at the department or college level.
(Include as separate page(s).It is not necessary to add page numbers in this section.)
I.TEACHING ABILITY AND PERFORMANCE
In chronological order, list courses taught by the candidate SINCE the last personnel action. (post-doctoral data may not be included). Note any release time for sabbatical, fellowships or any other reason.
A. ACTIVITIES
1. Courses Taught
"Required" refers to courses that all students must take in order to complete a degree program or specialization, including minors and/or concentrations. “Selective” refers to courses that are on a list of two or more courses from which the student must select one or more in order to complete a degree program or specialization. “Elective” refers to courses that are not required for any degree but which may be used toward elective hours in a degree program.
# / Semester/ Term / Course # / Course Title / Team Taught(Yes/No) / Credit Hours / Required/
Selective/ Elective / Enrollment
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2. Graduate Students
2.a.Graduate Student Advising and Supervision.
Check here if none and explain
# / Name of Student / Beginning and Completion Dates / Degree; Thesis Title; Role(Chair, advisor, or committee member)
1
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2.b. Graduate Student Exam Committee
Check here if none
# / Academic Year / # of Committees1
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3. Undergraduate Advising and Supervision:
Including that related to Honors College. (Service and activities related to student organizations in Section 3, E)
Check here if none
# / Name of Student / Semester and Year / Nature of Advising/Supervision (e.g – independent study, Honors College Capstone, Honors College Fellow work)1
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4. Residents and Post-Doctoral Fellows Supervised.
Check here if none
# / Name / Beginning and Ending Dates / Nature of Supervision1
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5. Direction of Research Associates, Visiting Scholars, and Technicians.
Check here if none
# / Name of Research Associates / Beginning and Ending Dates / Nature of Supervision1
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Check here if none
# / Name of Visiting Scholars / Beginning and Ending Dates / Nature of Supervision1
2
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Check here if none
# / Name of Technicians / Beginning and Ending Dates / Nature of Supervision1
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6. Contributions to Instructional Techniques, Software and Teaching Materials:
Include the creation and implementation of new courses.
Check here if none
7. Other Teaching Activities External to UIC:
Include the location of the course, name/description of the course, dates taught, credit hours, and number of students enrolled.
Check here if none
8. Other Significant Teaching Recognition/Achievement not Covered in the Five-Year Period
Check here if none
B. EVALUATION OF TEACHING AND RELATED ACTIVITIES
Please provide teachingevaluations for courses listed in 1 A. 1. Courses Taught.
1. Summary of Student Evaluations of Faculty Teaching.*
*It is inappropriate to ask current doctoral students supervised by the candidate to write a teaching evaluation for the candidate.Summarize below the results of student evaluations of the candidate's teaching ability.
DEPARTMENTS MAY USE AN ALTERNATE FORM FOR SUMMARIZING STUDENT EVALUATIONS; HOWEVER, STUDENT EVALUATIONS MUST BE PRESENTED AS SUMMARIZED DATA.
# / Semester/Term / Course Number / Course Title / *Average Rating
+ SD / (n/N)
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*Average of students' ratings of the "Overall Teaching Effectiveness" (or equivalent) of the candidate, on a scale of 5 (Excellent) to 1 (Poor). SD = standard deviation; n = number of students who rated the
candidate in that course; N = total number of students in that course.
2. Formal Recognition of Distinction in Teaching.
Please indicate nature of and criteria for recognition as well as the dates of awards.
Check here if none
3. 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.It is not necessary to add page numbers in this section.
II.RESEARCH/SCHOLARSHIP ABILITY AND ACHIEVEMENT
A. HONORS AND AWARDS ETC SINCE RECEIVING TERMINAL DEGREE
(List in chronological order)
Check here if none
B. INVITED COLLOQUIA AND SYMPOSIA
These must be invited. In chronological order, list invited colloquia/symposia since last personnel action and please describe and specify the significance of each colloquium/symposium listed. (post-doctoral data may not be included). (Do NOT list here presentations at professional meetings but place them under G.5)
Check here if none
C. OTHER INVITED PRESENTATIONS (e.g., LECTURES, WORKSHOPS, etc.)
These must be invited. In chronological order, list other invited presentations since last personnel action and please describe and specify the significance of each presentation listed. (post-doctoral data may not be included). (Do NOT list here presentations at professional meetings but place them under G.5)
Check here if none
D. OTHER EVIDENCE OF RECOGNITION
In chronological order, list other evidence of recognition since last personnel action. For faculty who are on a Q contract; who are in the non-tenure track having switched from the tenure track; who were moved into the tenure track from the non-tenure track; or who started their probationary year higher than T1, please include data since the last personnel action or for the past five years, whichever period is longer (post-doctoral data may not be included).
Check here if none
E. LICENSING/CERTIFICATION SINCE RECEIVING TERMINAL DEGREE
Check here if none
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F. SPONSORED RESEARCH ACTIVITIES
In chronological order, list sponsored research activities for a period not longer than the most recent five years (post-doctoral data may not be included). List all grant applications, even if unfunded. For faculty who are on a Q contract; who are in the non-tenure track having switched from the tenure track; who were moved into the tenure track from the non-tenure track; or who started their probationary year higher than T1, please include data since the last personnel action or for the past five years, whichever period is longer (post-doctoral data may not be included).
# / Date ofSubmission / Role of Candidate* / Agency / Title of Proposal / Amount**
Requested / Amount**
Funded / Funding Period
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*List PI name, if other than candidate.
**In multi-investigator projects, list both total amount and amount attributable to candidate, e.g., $375,750/$123,000. Indicate whether amount is total cost (TC), i.e. direct + indirect, or total direct cost (TDC). Funding and submissions are subject to verification by the Office of the Vice Chancellor forResearch.
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G. PUBLICATIONS, PAPERS, AND OTHER SCIENTIFIC, CREATIVE OR SCHOLARLYWORKS
For faculty who switched from the tenure-track to the clinical non-tenure track, please include data since last personnel action or the last 5 years, whichever period is longer (post-doctoral data may not be included).
List in chronological order. Include: books, monographs, edited volumes and translations, articles refereed in journals (do not abbreviate titles; give inclusive page numbers. 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), other articles (give inclusive page numbers) including bulletins, technical reports, chapters in books, book reviews, creative works (e.g., poetry, composition, exhibitions), patents, or other publications such as notes and comments.
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-authored publications in the discipline, please provide a brief summary of the practice.
1. Publications or Other Creative Work Relevant to the Discipline (BEFORE)
Dated BEFORELast Personnel Action(A personnel action is defined as the initial appointment date or effective date of most recent promotion or track switch).
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.
If there is certain significance in the order of authors in multi-author publicationsin the discipline, please provide a brief summary of the practice).
Check here if none
d.Refereed abstracts and conference proceeding articles
(Do not abbreviate titles; give inclusive page numbers. If there is certain significance inthe order of authors in multi-author publications in the discipline, please provide a briefsummary of the practice).
Check here if none
e.Other articles, including bulletins and technical reports
(Give inclusive page numbers.)
Check here if none
f.Chapters in books
(Give inclusive page numbers.)
Check here if none
g.Book reviews
(Give inclusive page numbers.)
Check here if none
h.Creative works
(e.g., poetry, composition, exhibitions)
Check here if none
i.Patents
Check here if none
j.Other (e.g., notes and comments)
Check here if none
2. Publications or Other Creative Work Relevant to the Discipline (SINCE)
Dated SINCE Last Personnel Action(A personnel action is defined as the initial appointment date or effective date of most recent promotion or track switch).