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Reappointment Application

First Name (required)

Last Name (required)

Current Address (required)

Phone (required)

Email (required)

Current Rank:

Curriculum Vitae:

Note: Only files with extension jpg, jpeg, png, gif, pdf, doc, and docx will be accepted; and the file-size limit is 2MB. If your file has a different extension or is larger than 2MB, please send it as an email attachment to imcoord@hawaii.edu.

I agree to spend 60 hours in each calendar year in formal teaching activities. (Please select YES or NO)

Use CTRL + click for PC or Command + click for Mac to select multiple activities
This time will be spent in the following teaching activities (select all that apply):

Over the last THREE years, I have participated in the following teaching activities in the Department of Medicine (check all that apply):

Please provide the number of hours (or any additional information) for the activities you indicated above.

Please follow this format:

Number from List Above. Title (if applicable), Number of Hours, and Additional Information.

For example:
4. Clinical Skills Preceptor, 30 Hours, Student Names: Elizabeth Farr, Laura Hsu, Ryder Onopa, Keane Young
5. PBL Tutor, 40 Hours
7. Medical Team Care Attending at Queen's Medical Center, 65 Hours, etc.

Hours and details for the activities listed above:

I have participated in the following community service:

Please list your recent abstracts, reports, manuscripts and publications:

I have read the guidelines for appointment and wish to remain a member of the Clinical Faculty:

Questions? (You can also call Erika Klimecki at 808-586-7460 or email her at imcoord@hawaii.edu)

Also, you can leave any comments you have here: