Instructor Temporary Contracts by mjs17436


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									                                                                          UT MEDICAL SCHOOL AT HOUSTON
                                                                           FACULTY REQUEST TO RECRUIT

               Date:                                              Department:
                                                                  Division (if applicable):

               Rank:                                              Track:                                     Degree:                               FTE:
                   Instructor                                           Non-Tenure, Clinical Track
                   Assistant Professor                                  Non-Tenure, Research Track
                   Associate Professor                                  Tenure Track without Tenure
                   Professor                                            Tenured
                  Other                                                 Clinical and Adjunct (Part-time)

               New                or replacement for                                           who terminated                             (month/year).

               Position was included in the last budget submission as:
                   Vacant                  New Position                              Budgeted, but under a different name:
                   Amount included in Budget: $                                         Not included in Budget

               Is this a temporary appointment?                   Yes             Dates of appointment:                                  through

               Anticipated appointment date:

               Name of Candidate, if known:

               If candidate is identified, does candidate currently hold Texas Medical license? (Note: Instructors do NOT qualify for Faculty Temporary
                   Permit. Institutional training permits are not allowed for faculty positions.)       Yes
                                                                                                        No                Date anticipated

               Is additional space (lab or office) needed?                                                       Yes               No
                  If yes, has the department Chair authorized reallocation of department space? Yes                                No

               Compensation (Business Plan and Compensation Equity Analysis must be attached)
                                                    Full-time Annual Compensation                            Pro-rated Annual Compensation (if <1.00 FTE)
                  Core                              $                                                        $
                  Discipline Specific               $                                                        $
                  Sub-Total: Core + Disc. Spec.     $                                                        $
                  Augmentation                      $                                                        $
                  Administrative Supplement         $                                                        $
                  Other Supplement(s)(A)            $                                                        $
                    TOTAL COMPENSATION                            $                                          $

                             Describe duties associated with each supplement(s):

               Source of Funding on an Annual Basis:
                 MSRDP funding                                    $
                 State funding                                    $
                 HCHD                                             $
                 Non-MSRDP Contracts or Grants                    $                                          Source:
                  TOTAL                                           $

               List any other financial commitments or costs associated with filling this position:
                  Cell Phone Supplement:                  Yes                      No
                  CDS Supplement                          Yes                      No
                  Moving Expenses:                        Yes                      Amount $                                         No
                  Other (specify types and amounts):


                  DMO                                                            Date                        Prepared by                                   Extension

                  Division Director                                              Date                        • Actual Base + Augmentation compensation amount must
                                                                                                               be within 5% of approved compensation levels.
                                                                                                             • Approval valid for up to one (1) year. If more than one
                                                                                                               year has elapsed prior to submission of revised RTR/offer
                  Chair                                                          Date                          letter template, department must consult with Administration
                                                                                                               Office before making an offer.

               I have approved this RTR pending approval by GPFG, if applicable.

                                                                                                                             Required Attachments:
                  Dean/Designee                                                  Date                                                     Business Plans
                                                                                                                                          Compensation Equity Analysis

C:\Docstoc\Working\pdf\058fc405-2302-4977-bf6c-c07151242e97.xls                                                                                                               Revised 6/28/07

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