REVIEW SHEET FACULTY RENEWAL LEAVES
ATTACH NARRATIVE REQUEST FROM FACULTY MEMBER AND OTHER SUPPORTING DOCUMENTS
(PLEASE TYPE)
NAME: _________________________________________________________________________________________________________________
SCHOOL: _____________________ DEPARTMENT: __________________________________________________________________________
CURRENT FACULTY TITLE: ___________________________________________ TENURE STATUS: G Tenured G Tenure track G Non tenure
CURRENT ADMINISTRATIVE TITLE (if any): ___________________________________________________________________________________
NO. OF YEARS AT RUTGERS:_____________________________ NO. OF YEARS SINCE LAST FACULTY RENEWAL LEAVE: ______________
PROPOSED EFFECTIVE DATES: ____________________________________________________________________________________________
SCHOOL COMMITTEE VOTE: _____________________________________________________________________________________________
MAJOR TEACHING DUTIES:
______________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
MAJOR CLINICAL DUTIES: _________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
MAJOR SERVICE ACTIVITIES: ______________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
MAJOR RESEARCH/SCHOLARSHIP ACTIVITIES: ______________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
EXTERNAL FUNDING AS PRINCIPAL INVESTIGATOR:
Current
Total (started within the past five years)
Federally-funded:
No. _________
Direct amt. $ ____________
No. _________
Direct amt. $ ____________
Industry-funded clinical trials:
No. _________
Direct amt. $ ____________
No. _________
Direct amt. $ ____________
Other:
No. _________
Direct amt. $ ____________
No. _________
Direct amt. $ ____________
No. _________
Direct amt. $ ____________
EXTERNAL FUNDING AS CO-PRINCIPAL INVESTIGATOR (Optional):
No. _________
Direct amt. $ ____________
LIFETTIME PUBLICATIONS: Peer-reviewed journals: No. of original papers: _________
No. of original papers as principal author: _______
No. of review articles: _______ No. of editorials, other invited articles: _______ No. of books: _______ No. of book chapters: ______
OTHER ACCOMPLISHMENTS, HONORS, AWARDS, ETC.: _______________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________
DEAN’S/CHAIR’S NAME
(REPROODUCE ON GREEN STOCK)
_________________________________________________________________________
DEAN’S/CHAIR’S SIGNATURE
DATE
Revised: July 1, 2013