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

 

 

 

  1. Program _______________________________________________________________________

       (Nursing, Physical Therapy, etc.)   

 

  1. Faculty’s Name with credentials____________________________________________________

 

  1. Proposed Rank:_________________________________________________________________

 

  1. Proposed appointment date: ______________

 

  1. Length of Appointment:_____________

 

  1. Degree(s) and Universities

 

 

 

  1. Previous Academic Experience

 

 

 

 

  1. 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