APPLICATION FOR RE-APPOINTMENT All UCD Adjunct Appointments are for a maximum of five years. Hence it is necessary to apply for re-appointment at the same academic rank. This form should be used by existing UCD Clinical Pathway appointees wishing to retain their appointment. First-time applicants should NOT use this form. Please complete this form fully to ensure that the Review Panel has all relevant information on which to make a decision. Detailed curricula vitae, testimonies or personal references will not be considered. Please submit completed application form by email to clinicalpathway@ucd.ie.
PERSONAL & CONTACT DETAILS
Name:	Click here to enter text.
Current Position:	Click here to enter text.
Institution:	Click here to enter text.
Home Address:	Click here to enter text.
UCD Address:*	Click here to enter text.	UCD Personnel No.*	Click here to enter text.
Telephone:	Click here to enter text.	PPS No.:	Click here to enter text.
E-mail:	Click here to enter text.	* if applicable

Current Appointment (Pre-2015 Academic Titles in parenthesis)	Year of Appointment:
UCD Assistant Clinical Professor ☐	UCD Associate Clinical Professor ☐	UCD Clinical Professor ☐	UCD Full Clinical Professor ☐
(UCD Clinical Lecturer)	(UCD Senior Clinical Lecturer)	(UCD Associate Clinical Professor)	(UCD Clinical Professor)

Evaluation Criteria
(Please describe additional achievements or contributions since previous appointment which may justify promotion or reappointment.)
Research Scholarship & Innovation
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Clinical & Academic Leadership
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Teaching, Learning & Assessment
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Other Relevant Information
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FOR OFFICE USE ONLY - APPLICATION VERIFICATION and STATEMENT OF SUPPORT

Dear Section Leader,

The attached application has been made under the UCD Medicine Clinical Pathway. Please review the application form and provide your assessment of the individual’s contribution to our academic programmes.

Comment by Section Leader Please provide any relevant context or background information on the contribution of the applicant to academic or clinical activities in the domains of:
Research, Scholarship & Innovation
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Clinical & Academic Leadership
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Teaching, Learning & Assessment
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Summary Relative strength of contribution in each area.
Research, Scholarship & Innovation Modest ☐ Normal ☐ Strong ☐ Very Strong ☐
Clinical & Academic Leadership Modest ☐ Normal ☐ Strong ☐ Very Strong ☐
Teaching, Learning & Assessment Modest ☐ Normal ☐ Strong ☐ Very Strong ☐

I verify that the information provided above by the applicant is, to the best of my knowledge, correct. I support this application and will be willing to provide any further information required by the Review Panel.

Name: Click here to enter text.
Title: Click here to enter text.