DRAFT PVL # __________ FACULTY RECRUITMENT AUTHORIZATION REQUEST UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH Updated 12/20/2010 REQUEST SUMMARY Use this form for position requests that do not have a clinical component Send one copy to Cindy Derenne, 4150Z Health Sciences Learning Center Department: Request Prepared Date: Sub-Department/UDDS: Percent Appointment : Position Title: Proposed Salary Range: Title Code: Incumbent’s Salary: Proposed Hire Effective Date: New_ _; Replacement or Partial Replacement Contact Name: Incumbent’s Name: Contact Phone: Incumbent’s Title: Incumbent’s Departure Date: Incumbent’s Reason for Leaving (retirement, resignation) or Reducing Appt. Note: include copy of incumbent’s letter of resignation/retirement/reduction *Provide salary info at full-time rate. Percent appointment and salary information listed above should match data provided within the document. SIGNATURE ______________________________________ Department Chair (required on all requests) ACTION (for School of Medicine and Public Health use only) School of Medicine and Public Health Dean’s Leadership Team (date): Approved_______ Deferred_______ Denied_______ I. PROGRAM STATEMENT Provide a rationale for this position and include: a. Synopsis of projected faculty role and relationship to Department and School of Medicine and Public Health Strategic Priorities. b. Anticipated relationship with faculty research and/or teaching programs in other UW departments, schools, colleges, disciplines, or centers (list potential collaborators below in III.2) Provide a response to the following questions, as relevant to this position: a. If the request is for a new position, what changes have occurred to require this recruitment? b. Is the position needed for academic accreditation? c. What is the impact on the department/program if the position is not filled? d. What is the impact of hiring this position on current faculty within the department/program? e. Does the hiring of this position impact other departments or programs? If so, please identify the department/s or program/s and the anticipated effect. f. For each department or program identified in “e” above, provide a brief synopsis of interactions you have had with the department or program leader/s concerning this position. II. DIVERSITY Identify the steps to be taken during this recruitment to encourage further the commitment of UW Madison and UW School of Medicine and Public Health to increasing ethnic and gender diversity among the faculty. If you need help identifying potential recruitment resources to broaden the pool of candidates, please contact the Office of the Associate Dean for Administrative Affairs. III. TIME COMMITMENT 1. Proposed time commitment (%) for position being requested: Teaching ____ Research ____ Service ____ Administration ____ Other ____ 2. Define the time commitment in the following grids: RESEARCH: For the research role envisioned for this position, indicate the likely area of concentration and probable collaborators. Area of Concentration Potential Collaborators TEACHING: Describe and quantify the projected time commitment and the teaching activities planned for this position, including, as applicable, medical student, graduate, undergraduate and post-graduate education. Be specific about courses and other responsibilities. If you have not identified a specific teaching role for this position, please provide information about the department’s established standard for teaching responsibilities of faculty at the rank/s requested. EDUCATION LEADERSHIP ROLES Course Name(s) Course # Student Group Leadership Responsibilities CLASSROOM AND LABORATORY TEACHING Course Name (s) & # # of Lectures # of Small # of Labs Total Group/Discussions Course Hours MENTORING AND ADVISING Name of Program # of Trainees Hours/Wk OTHER TEACHING Type of Activity Lectures/Month Courses per Month Total Commitment/Month ADMINISTRATION/LEADERSHIP: Estimate the projected time commitment and briefly describe the program. Basic Responsibilities IV. CURRENT SITUATION List all current faculty members in the Department, their total FTE commitment and approximate percentage of time devoted to each activity below. Faculty Member Total FTE Teaching Research Admin Other % % % % Highlight the individual/position being replaced. V. COMPENSATION 1. Provide proposed compensation funding sources and, if funding commitments have been received, the length of time each source is committed. COMPENSATION FUNDING $$ Number of years SOURCES commitment Department School of Medicine and Public Health Other source/s: Center funds Grants Special Campus funding(identify) TOTAL: a. Has the funding been agreed upon by all sources? b. If/when the funding source runs out what are the plans to fund the position? 2. If available, provide market information regarding compensation norms. Compensation Norms Source(s) & Discipline 10th % 20th % Median 75th % 90th % VI. RESOURCES: List all types of new resources likely to be needed for the faculty member’s academic program and the proposed funding sources for each. Include equipment, research space, research support staff, and other research start-up funds needed. Equipment Research Lab Support Staff Other Research Start- Proposed Source Space (sq. ft.) up Funds VII. SEARCH COMMITTEE: Include a listing of the proposed search committee chair and membership.
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