Main Content Information Name First Middle Initial Last Suffix UW Email Alternate Email Current organization you are associated with (i.e. work for) Do you hold a current clinical, adjunct, or affiliate faculty appointment within the School of Nursing & Healthcare Leadership? Yes No UWT SNHCL Annual Clinical, Adjunct, & Affiliate Faculty Appointment Renewal What is your current courtesy appointment type? Clinical Faculty Adjunct Faculty Affiliate Faculty Would you like to continue your courtsey faculty appointment in the UWT SNHCL for the upcoming academic year? Note: Answering "Yes" does not guarantee that your appointment will be renewed. The UWT School of Nursing & Healthcare Leadership will take your renewal interest into account, but final decisions about appointment renewals are made on the basis of organizational needs. Yes, I would like this faculty appointment to be renewed. No, I would not like this faculty appointment to be renewed. If you answered "No" above, please explain why you would prefer not to continue your role with SNHCL. UWT SNHCL Annual Clinical, Adjunct, & Affiliate Faculty Appointment Renewal Survey What activities were you engaged in with the School of Nursing & Healthcare Leadership during this past academic year? Teaching or co-teaching of courses Guest lecturing/Seminar participation Precepting Supervising practica or course fieldwork Conducting research with SNHCL faculty Consulting Grant Work Other… Enter other… What activities do you hope or plan to engage with the UWT School of Nursing & Healthcare Leadership during the upcoming academic year? Teaching or co-teaching of courses Guest lecturing/seminar participation Precepting Supervising practica or course fieldwork Conducting research with SNHCL faculty Participating in advisory or governance groups for a program or department Consulting Grant Work Other… Enter other… Please indicate which professional license(s) you have (check all that apply). RN ARNP CNM MD Physician Assistant EMS Psychologist Advanced Social Worker Independent Clinical Social Worker Mental Health Counselor Marriage and Family Therapist Other… Enter other… List your first or primary license type, license number, and license expiration date. Re-order Primary License Type License Number License Expiration date Weight Operations Primary License Type License Number License Expiration date Item weight If you have additional licenses, please list the type,number, AND expiration date (to add more than one, click on the plus button to the far right). Re-order License type License Number License Expiration Date Weight Operations License type License Number License Expiration Date Item weight Add more items more items Please upload your updated CV/Resume One file only.15 MB limit.Allowed types: pdf. UWT SNHCL New Clinical, Adjunct, & Affiliate Faculty Requirements If you have been nominated for an appointment as a non-paid courtesy appointment (Clinical Faculty, Adjunct Faculty, or Affiliate Faculty) within the School of Nursing and Healthcare Leadership (SNHCL) by a current SNHCL faculty member, please read and complete the following information. Courtesy faculty appointments are afforded to individuals whose training/experience positions them to make valuable contributions to the mission of the school. Upon recommendation of the SNHCL faculty and approval of the Dean, your appointment will be for the next academic year (July 1 - June 30) with the option of renewal thereafter. If you are interested in becoming a Courtesy Faculty member within SNHCL, please upload the following documents by the Last Monday of February. Documents Needed to Complete Form: Current CV Biography Sheet New Scholarship Sheet Three Recommendations/Reference Letters on letterhead (3 preferred, 1 mandatory) Transcript (can be unofficial) with highest degree earned Sincerely, David Reyes, DNP, MPH, RN, PHNA-BC Dean, UW Tacoma School of Nursing and Healthcare Leadership Which SNHCL faculty nominated you for a courtesy faculty appointment? 1. Current CV One file only.15 MB limit.Allowed types: pdf. 2. A Biography Sheet One file only.15 MB limit.Allowed types: pdf. 3. A New Scholarship Sheet One file only.15 MB limit.Allowed types: PDF. 4. Recommendation Letter/Reference #1 (on letterhead) One file only.15 MB limit.Allowed types: pdf. 5. Recommendation Letter/Reference #2 (on letterhead) One file only.15 MB limit.Allowed types: pdf. 6. Recommendation Letter/Reference #3 (on letterhead) One file only.15 MB limit.Allowed types: pdf. 7. Transcript (can be unofficial) with highest degree earned One file only.15 MB limit.Allowed types: pdf. Leave this field blank
