Non-Voting Faculty Appointment Form
MGH Institute of Health Professions
Non-Voting Faculty Appointment Form
Please attach the candidate’s Curriculum Vitae with this form.
Key academic leader at the Institute
Key leader in major affiliates
Adjunct faculty member
- Program _______________________________________________________________________
(Nursing, Physical Therapy, etc.)
- Faculty’s Name with credentials____________________________________________________
- Proposed Rank:_________________________________________________________________
- Proposed appointment date: ______________
- Length of Appointment:_____________
- Degree(s) and Universities
- Previous Academic Experience
- Write a brief justification below or attach a letter specifically addressing the Criteria and Interpretive Statements for requested rank.
SIGNATURES: Please obtain in this order.
(1) _______________________________________________________________________________
Dean Date
(2)_______________________________________________________________________________
Provost Date