faculty-recruitment-authorization-basic-science by mudoc123


									                                                                                    DRAFT PVL # __________

                       FACULTY RECRUITMENT
                      AUTHORIZATION REQUEST
                                                     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.


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_______
       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.

       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.


       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

                Course Name (s) & # # of Lectures # of Small                            # of Labs       Total
                                                  Group/Discussions                                     Course

                          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

      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.

       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
         School of Medicine and Public Health
         Other source/s:
           Center funds
           Special Campus funding(identify)


          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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