Annual Salary Review form

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					     APPLICATION FOR THE AWARD OF AN ACADEMIC ADDITIONAL PROGRAMMED
               ACTIVITY (APA) FOR THE PERIOD 1 APRIL 2012 – 31 MARCH 2013
                     for Clinical Academic Staff at Honorary Consultant Level

           Note: Please be aware that Clinical Academic staff in receipt of 1.0 or more Clinical APAs
                           are not eligible for an Academic APA for the same period.




Full Name (please print):


University Contact
Address:


University Email Address:
Number of Academic APAs applied for:
Please state the number of Academic APAs for which you are applying (e.g. 1.0, 0.5) Please note
the Panel may at its discretion award less than 1.0 APA.


Number of expected Clinical APAs for the period 1 April 2012 – 31 March 2013
Note: Please be aware that Clinical Academic staff in receipt of 1.0 or more Clinical APAs are not eligible
for an Academic APA for the same period.


Please indicate below the relevant area(s) of Academic activity on the strength of which your
application is being submitted.




1.
     Confirmed achievement of substantial innovation in teaching / student support;
                                                                                                              

2.   Exceptional new grants, publications in print or contract awards in the period 1 January –
     31 December 2011;                                                                                        

3.   Evidence of significant University and regional academic contribution with high positive
     impact;                                                                                                  

4.   Evidence of exceptional external recognition for academic achievements in the period 1
     January – 31 December 2011;                                                                              

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5.   Evidence of other exceptional academic contribution that has brought prestige to the
     University.                                                                                 

Supporting Statement – Please attach to your application form a statement evidencing academic
activity within the period 1 January – 31 December 2011 (maximum 2 pages) in support of your
application. This should include an appendix listing grants obtained and publications in print for
the 2011 calendar year and teaching hours for the last academic year (2010-11). Information
regarding your academic achievement should be presented in a bullet point list. Please ensure
your name is included on the supporting statement. CVs or additional appendices will not be
accepted.


Supporting statement attached? (please tick)                                                      
Signed:                                                     Date:

Applications need to be received by Gayle McKeachie g.mckeachie@sheffield.ac.uk in the Department of
                                  Human Resources by 1 February 2012.
               Please note that applications received after this date will not be considered.




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