Academic Activity Report Form

  • Institution email if affiliated faculty appointment.
  • Eligibility for Continued Faculty Appointment

    Affiliated, community-based and adjunct faculty, please describe your current contributions to the academic programs and/or research mission of the School of Medicine from January 1, 2016 to December 31, 2016
  • List Undergraduate (UME) and Graduate Medical Education (GME) Activities.
  • List the grants you collaborate on.
  • List administrative and committee work.
  • This field is for validation purposes and should be left unchanged.

Explanatory Notes

Educational Activities: Faculty members are expected to participate in teaching activities during rounds in the office, in the operating room, or in small group conferences at UConn and off-site, including community outreach.

Research Activity: If you are involved in research activities, please list the percent effort in time and the percent of salary covered by grants during the year under review.

Service to UConn Health: List any administrative or committee work for your hospital or the School of Medicine.