Application for Affiliate Faculty Appointment

Division of Community Health

College of Rural Alaska, University of Alaska Fairbanks

This application provides an opportunity for individuals employed by Community Health Aide Programs as an instructor to request Affiliate Faculty appointment at the University of Alaska-Fairbanks. Applications may be submitted at anytime. Appointments are issued October 1 and March 1 of each year.

Please mail this application, your CV (including names of two references), and copy of licensure to:

Linda Curda, CHAP Academic Liaison

Kuskokwim Campus, UAF

P.O. Box 368

Bethel, AK 99559

(907) 543-4523

Name: ______Job Title: ______

Address: ______

Social Security Number: - - Phone:

Employer:

Nearest University of Alaska Campus:

______

Applicant SignatureDate

------

(Division and CRA use only)

The above named applicant is approved for Affiliate Faculty appointment to the Division of Community Health.

College of Rural Alaska, UAF as (please check one):

Clinical Instructor

Clinical Assistant Professor

______

Chair, Division of Community HealthDate

______

Campus DirectorDate

______

Executive Dean, College of Rural AlaskaDate

Div. CH 10/02(instructions over)

Division of Community Health, College of Rural Alaska

University of Alaska-Fairbanks

These instructions are intended to assist individuals employed in CHA/P programs as an instructor interested in obtaining affiliate clinical faculty status within the College of Rural Alaska, University of Alaska Fairbanks.

These steps will be followed:

  1. Applicant requests affiliate faculty appointment.
  2. Application form, current CV (including names of two references), and copy of licensure are sent for review and approval.
  3. Division and campus approvals are obtained and application form is sent to the Executive Dean of the College of Rural Alaska for official appointment.
  4. Letter of appointment is sent to affiliate faculty member.
  5. Letter of appointment is signed and sent to Executive Dean’s office (affiliate faculty retains a copy).

Affiliate clinical faculty appointments will be made considering professional credentials as the required terminal degree:

AppointmentCredential Requirements

CHP/RN/otherNP/PA/MD

Clinical Instructor X

Clinical Instructor Professor X

Approval Means:

Clinical Instructor: can sign as instructor of record all catalog CHP courses except “basic training” courses

(CHP 131 through 135 series, see Review and Approval Committee Standards).

Clinical Assistant Professor: can sign as instructor of record for all catalog and special topics CHP courses.

Affiliate Faculty responsibilities:

  1. Participate in student advising for the UAF Community Health Certificate and Associate of Applied Science Degree.
  2. Network with other faculty.
  3. Keep current on University policies and procedures relating to the CHA/P program to provide accurate student advising.
  4. Participate in academic review processes relating to CHP courses.

Affiliate Clinical Faculty appointments continue with ongoing employment within the CHA/P program.

Div. CH 9/97(Application form over)