| UMKC School of Medicine

CV and Career Counseling Program Application

This information will provide background to guide counseling session with the Associate Dean for Professional Development.

Information may be used for education research purposes to be shared as group data only (for example, tracking data responses by faculty rank type). No personal identifiers will be used.

I give permission to have my responses shared as group data only for research purposes*

Name*

First

Last

Degree*

Email*

Phone

Current Position*

Year started as School of Medicine (SOM) faculty*

Current academic rank*

Year(s) at this rank*

Your Academic department (and division/section as applicable):*

Are you clinically active at one of the affiliates*

If you are clinically active, which affiliate is your majority of time spent at

Do you intend to apply for promotion in*

Why do you want to meet and what do you hope to learn [describe your specific question(s) or subject(s)]? (50 word or less)*

Are you interested in participating in the Longitudinal/On-going Mentoring Programs*

Please share why you responded as you did (50 words or less)*

For promotion and career progression/fulfillment, which scholarly activity categories most interest you? (Choose up to 2)*

Teaching

Service

Clinical Practice

Research

Please upload a copy of most recent CV.

Thank you for participating.

After your submission, the Office of Professional Development will be in touch with you to schedule an appointment based on availability.