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UNC Eshelman School of Pharmacy 201 Annual Faculty Activity Report & 201 Career Planning Document
I. 2014 Annual Faculty Activity Report DEMOGRAPHICS PID: Email: Name (First, Middle, Last):
Division: Chemical Biology and Medicinal Chemistry Molecular Pharmaceutics Pharmacotherapy and Experimental Therapeutics Pharmaceutical Outcomes and Policy Practice Advancement and Clinical Education Faculty Rank: Professor Associate Professor Assistant Professor Appointment Series: Tenure Track Clinical Track Research Track Adjunct (for PACE only)
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TEACHING
Didactic Courses Please complete the table below for the courses you taught during the 2014 calendar year.
Course Number
Course Title
(abbreviations are sufficient)
Credit Hours
Course Type
Program Course Director
Semester Enrollment
Number of lecture or
in-class contact hours
Number of small
group or recitation
contact hours
where you played an active role in teaching
or facilitating discussion
Number of other
teaching-related hours
for courses or seminars
(e.g., attending class when
not teaching, preparing for
lectures, grading, office
hours)
Total hours
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lizhayesTypewritten Textof a specific course. This information is captured later in the document as it relates to numbers of students mentored. Course-related mentoring
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lizhayesTypewritten TextNote: This table is not intended to capture time spent mentoring graduate students, PharmD students, residents, fellows, or advisees
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Course or
Seminar Number
Course or Seminar Title
(abbreviations are sufficient)
Credit Hours
Course Type
Program Course Director
Semester Enrollment
Number of lecture or
in-class contact hours
Number of small
group or recitation
contact hours
where you played an active role in teaching
or facilitating discussion
Number of other
teaching-related hours
for courses or seminars
(e.g., attending class when
not teaching, preparing for
lectures, grading, office
hours)
Total hours
Total (all courses)
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For courses in which you co-directed or taught in 2014, briefly summarize findings from your course / instructor evaluation and be prepared to share your evaluations with your Division Chair:
Describe any pedagogical innovations that you introduced into your course(s) in 2014 (e.g., new classroom technologies, new active learning approaches, new assessment strategies) and any reflections you may have regarding the experience.
Total number of Instructional Innovation Policy and Participation Agreements in 2014
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Advising, Precepting, and Mentoring (names, titles and other details should appear in CV)
Total number of PharmD student advisees you were responsible for in 2014
Total number of PharmD student research projects or honors projects supervised in 2014
Total number of PharmD students precepted on IPPE rotations in 2014
Total number of 4th year PharmD students precepted on clerkships in 2014
Total number of resident research projects supervised in 2014
Total number of residents for whom you were the primary director and/ or mentor in 2014
Total number of residents precepted in 2014
Total number of Masters theses supervised in 2014
Total number of graduate students for whom you were the primary advisor/mentor in 2014
Total number of student dissertation committees that you served on in 2014
Total number of PhD students graduated in 2014 for whom you served as major advisor
Total number of post-doctoral fellows for whom you were the primary advisor/mentor in 2014
Total number of visiting scientists for whom you were responsible in 2014
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PUBLICATIONS (for the period of January 2014 - December 2014)
Total number of peer-reviewed manuscripts+ published in 2014
Total number of peer-reviewed manuscripts+ published as first author in 2014
Total number of peer-reviewed manuscripts+ published as senior author in 2014
Total number of peer-reviewed book chapters published in 2014
Total number of peer-reviewed book chapters published as first or senior author in 2014
Total number of peer-reviewed+ manuscripts accepted and in press as of Dec. 2014
Total number of non-peer-reviewed publications in 2014
Total number of peer-reviewed abstracts published/presented in 2014
Total number of manuscripts, book chapters, other articles submitted and under review as of Dec. 2014
+ Peer-reviewed manuscripts include any form of peer-reviewed paper (e.g., original research, review articles)
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Manuscripts (e.g., original research, reviews), Book Chapters, and Other Articles that have been submitted and are under review
Please complete the table below. Note: This information is typically not included on a CV, so is requested here. Published and accepted/in press manuscripts should appear on the CV, so are not necessary to list on this form. Space is provided for 10 titles; if you have more than 10, space is provided for you to briefly summarize additional works at the end of the table.
Title, Journal Your Role
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Title, Journal Your Role
If you have more than 10, briefly summarize the focus of the work and/or your role on the papers:
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PATENTS, INVENTION DISCLOSURES, LICENSE AGREEMENTS, AND CLINICAL TRIALS (details should appear on CV)
Total number of patents issued in 2014
Total number of patent applications in 2014
Total number of invention disclosures in 2014
Total number of license agreements in 2014
Total number of IRB-approved clinical trials initiated in 2014
INVITED PRESENTATIONS AND LECTURES (titles and other details should appear on CV)
Total number of invited presentations or lectures at regional or state meetings in 2014
Total number of invited presentations or lectures at national professional meetings (in US) in 2014
Total number of invited presentations at professional meetings held at international locations in 2014
Total number of invited presentations or lectures at other universities in 2014
Total number of invited presentations or lectures at other venues not listed above (e.g., foundations, companies) in 2014
HONORS AND AWARDS (should not include elected appointments to committees or offices/positions held within associations)
Total number of university honors and awards received in 2014
Total number of state honors and awards received in 2014
Total number of national honors and awards received in 2014
Total number of international honors and awards received in 2014
Have you been awarded fellow status in any professional association at any point in your career? YES NO
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SERVICE
Total number of committees on which you served within the School in 2014
Total number of committees on which you served within the University or Hospital in 2014
Total number of committees, task forces, or other working groups on which you served nationally or internationally
Total number of grant study sections on which you served in 2014
CERTIFICATIONS (certification titles, dates, and other details should appear in CV)
Are you certified by the Board of Pharmacy Specialties? YES NO NA
Do you have added qualifications in board certification through the Board of Pharmacy Specialties? YES NO NA
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GRANTS, CONTRACTS, AND UNFUNDED RESEARCH PROJECTS (include all grants, contracts, and unfunded research projects for 2014)
Please complete the following three tables for: (1) grants/contracts submitted and pending, (2) grants/contracts submitted and not funded, and (3) active research projects that are not funded. For each of the three categories, space is provided for 10 entries; if you have more than 10, space is provided for you to briefly summarize additional grants/contracts at the end of each table.
Note: This information is typically not on CVs, so it is requested here. We are unable to pull this information for all faculty prior to the annual reviews with your chair. Active grants that are funded should appear on the CV, so are not requested here. 1. Submitted in 2014 and Pending
Title
Funding Agency Your Role Your % Effort
Approximate Estimate of Total Direct Costs
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Title
Funding Agency Your Role Your % Effort
Approximate Estimate of Total Direct Costs
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If more than 10, please indicate total number of grants and contracts that have been submitted and are pending: ___________
Comments about additional grants/contracts:
2. Submitted and Not Funded in 2014
Title Funding Agency Your Role Your % Effort
Approximate Estimate of Total Direct Costs
Score (enter NA if not applicable)
Percentile (enter NA if not applicable)
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Title Funding Agency Your Role Your % Effort
Approximate Estimate of Total Direct Costs
Score (enter NA if not applicable)
Percentile (enter NA if not applicable)
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If more than 10, please indicate total number of grants and contracts that have been submitted and not funded: ___________
Comments about additional grants/contracts:
3. Current Research Projects That Are Not Funded
Title Your Role Your % Effort
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Title Your Role Your % Effort
If more than 10, please indicate total number of current research projects that are not funded: ___________
Comments about research projects:
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OTHER
Please use the space below, if needed, to offer additional comments about other accomplishments during the year not necessarily reflected here or on your CV.
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II. 2015 CAREER PLANNING DOCUMENT
AREA OF SCHOLARSHIP
Please indicate your primary area of scholarship (with a “1”) and, if a secondary focus applies, indicate this accordingly (with a “2”). Note: All areas of scholarship are described in greater detail in the School’s appointment, reappointment, promotion, and tenure (ARPT) document: http://pharmacy.unc.edu/about-us/school-organization/office-of-the-dean/arpt.pdf
Discovery: ___________ Education: ___________ Application: ___________
SALARY FUNDING SOURCES
Current Sources of Funding for Faculty Salary and Anticipated Changes / Goals for 2015
Note: This information can be found at: https://ecrt.unc.edu/ecrt/initWelcome.action. Once logged in, click the “Continue” button. You will see a circular diagram. Below the circular diagram click on “View My Effort.” We ask that you simply review this information at this time. Please beprepared to share and discuss this information with your chair, where appropriate. You may want to print this off and take to your meeting with you.
AREAS OF FOCUS
Percent Effort Devoted to Various Areas
Areas of Focus Estimated % Effort for 2014 Estimated % effort for 2015 Teaching Service Patient Care Research/Scholarship Administration Total
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Accomplishments, Challenges, and Future Goals
For each relevant area of focus listed below, please comment on your greatest accomplishments (2014), challenges encountered (2014), and future goals (2015). Provide explanations or indicate not applicable, where appropriate.
AREA OF FOCUS GREATEST ACCOMPLISHMENTS (2014) CHALLENGES ENCOUNTERED (2014) FUTURE GOALS (2015)
Teaching
Service
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AREA OF FOCUS GREATEST ACCOMPLISHMENTS (2014) CHALLENGES ENCOUNTERED (2014) FUTURE GOALS (2015)
Patient Care
Research/Scholarship
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AREA OF FOCUS GREATEST ACCOMPLISHMENTS (2014) CHALLENGES ENCOUNTERED (2014) FUTURE GOALS (2015)
Administration (e.g., Director, Assistant/Associate Dean, Residency Director, Chair, Vice Chair)
Other
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Faculty Development Needs
Please identify any needs you have from your Chair or the School to achieve your goals in 2015?
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LONG-TERM GOALS
Please list your key goals over the next 3-5 years.
1.
2.
3.
4.
5.
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Faculty Development Needs
Please identify any needs you have from your Chair or the School to achieve your long-term goals over the next 3-5 years?
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REFLECTION ON LAST YEAR’S REVIEW
Please outline any issues raised during last year’s review and how these were addressed in 2014.
1.
2.
3.
4.
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NOTE: The following section should be completed by the faculty member following the 2015 annual faculty-chair review meeting. The chair will have an opportunity to review and sign off on the entire document prior to final submission.
III. COMMENTS AND GUIDANCE OBTAINED FROM CHAIR DURING THIS YEAR’S REVIEW
AREAS OF FOCUS (FEEDBACK OBTAINED FROM CHAIR)
Teaching
Service
Patient Care
Research/Scholarship
Administration
Other
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LONG-TERM GOALS (FEEDBACK OBTAINED FROM CHAIR)
Thank you for completing the 2014 Annual Faculty Activity Report and 2015 Career Planning Document. Please enter the total amount of time (in minutes) it took you to complete this document: ___________ Please provide any comments or suggestions for improving this document and/or process. The feedback provided last year was very helpful in refining this year's document and process. Your continued feedback will be helpful in refinements for next year.
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FEEDBACK PROVIDED THROUGHOUT 2015 The following table provides a place to document feedback provided to the faculty member by the chair throughout the year.
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PID: Save to Infoporte: course/instructor evaluations: pedagogical innovations: Additional_Papers: Service_not_on_CV: Course or Seminar 1: Course or Seminar 2: Course or Seminar 3: Course or Seminar 4: Course or Seminar 5: Course or Seminar 6: Course or Seminar 7: Course or Seminar 8: Course or Seminar 9: Course or Seminar 10: Course or Seminar 11: Course or Seminar 12: Course or Seminar 13: Course or Seminar 14: Course or Seminar 15: Course or Seminar 16: Course or Seminar 17: Course or Seminar 18: Course or Seminar 19: Course or Seminar 20: Course or Seminar Title 1: Course or Seminar Title 2: Course or Seminar Title 3: Course or Seminar Title 4: Course or Seminar Title 5: Course or Seminar Title 6: Course or Seminar Title 7: Course or Seminar Title 8: Course or Seminar Title 9: Course or Seminar Title 10: Course or Seminar Title 11: Course or Seminar Title 12: Course or Seminar Title 13: Course or Seminar Title 14: Course or Seminar Title 15: Course or Seminar Title 16: Course or Seminar Title 17: Course or Seminar Title 18: Course or Seminar Title 19: Course or Seminar Title 20: Credit Hours 1: Credit Hours 2: Credit Hours 3: Credit Hours 4: Credit Hours 5: Credit Hours 6: Credit Hours 7: Credit Hours 8: Credit Hours 9: Credit Hours 10: Credit Hours 11: Credit Hours 12: Credit Hours 13: Credit Hours 14: Credit Hours 15: Credit Hours 16: Credit Hours 17: Credit Hours 18: Credit Hours 19: Credit Hours 20: Course Type 2: [Required]Course Type 3: [Required]Course Type 4: [Required]Course Type 5: [Required]Course Type 6: [Required]Course Type 7: [Required]Course Type 8: [Required]Course Type 9: [Required]Course Type 10: [Required]Course Type 11: [Required]Course Type 12: [Required]Course Type 13: [Required]Course Type 14: [Required]Course Type 15: [Required]Course Type 16: [Required]Course Type 17: [Required]Course Type 18: [Required]Course Type 19: [Required]Course Type 1: [Required]Course Type 20: [Required]Program 1: [Professional]Program 2: [Professional]Program 3: [Professional]Program 4: [Professional]Program 5: [Professional]Program 6: [Professional]Program 7: [Professional]Program 8: [Professional]Program 9: [Professional]Program 10: [Professional]Program 11: [Professional]Program 12: [Professional]Program 13: [Professional]Program 14: [Professional]Program 15: [Professional]Program 16: [Professional]Program 17: [Professional]Program 18: [Professional]Program 19: [Professional]Program 20: [Professional]CD 1: [No]CD 2: [No]CD 3: [No]CD 4: [No]CD 5: [No]CD 6: [No]CD 7: [No]CD 8: [No]CD 9: [No]CD 10: [No]CD 11: [No]CD 12: [No]CD 13: [No]CD 14: [No]CD 15: [No]CD 16: [No]CD 17: [No]CD 19: [No]CD 18: [No]CD 20: [No]Semester 1: [Spring 2014]Semester 2: [Spring 2014]Semester 3: [Spring 2014]Semester 4: [Spring 2014]Semester 5: [Spring 2014]Semester 6: [Spring 2014]Semester 7: [Spring 2014]Semester 8: [Spring 2014]Semester 9: [Spring 2014]Semester 10: [Spring 2014]Semester 11: [Spring 2014]Semester 12: [Spring 2014]Semester 13: [Spring 2014]Semester 14: [Spring 2014]Semester 15: [Spring 2014]Semester 16: [Spring 2014]Semester 17: [Spring 2014]Semester 18: [Spring 2014]Semester 19: [Spring 2014]Semester 20: [Spring 2014]Enrollment 1: Enrollment 2: Enrollment 3: Enrollment 4: Enrollment 5: Enrollment 6: Enrollment 7: Enrollment 8: Enrollment 9: Enrollment 10: Enrollment 11: Enrollment 12: Enrollment 13: Enrollment 14: Enrollment 15: Enrollment 16: Enrollment 17: Enrollment 18: Enrollment 19: Enrollment 20: Lecture_Hours_1: Lecture_Hours_3: Lecture_Hours_4: Lecture_Hours_5: Lecture_Hours_6: Lecture_Hours_7: Lecture_Hours_8: Lecture_Hours_9: Lecture_Hours_10: Lecture_Hours_11: Lecture_Hours_2: Lecture_Hours_12: Lecture_Hours_13: Lecture_Hours_14: Lecture_Hours_15: Lecture_Hours_16: Lecture_Hours_17: Lecture_Hours_18: Lecture_Hours_19: Lecture_Hours_20: Total_Lecture_Hours: 0Small_Group_Hours_1: Small_Group_Hours_2: Small_Group_Hours_3: Small_Group_Hours_4: Small_Group_Hours_5: Small_Group_Hours_6: Small_Group_Hours_7: Small_Group_Hours_8: Small_Group_Hours_9: Small_Group_Hours_10: Small_Group_Hours_11: Small_Group_Hours_12: Small_Group_Hours_13: Small_Group_Hours_14: Small_Group_Hours_15: Small_Group_Hours_16: Small_Group_Hours_17: Small_Group_Hours_18: Small_Group_Hours_19: Small_Group_Hours_20: Total_Small_Group_Hours: 0Total_Contact_Hours_1: 0Total_Contact_Hours_2: 0Total_Contact_Hours_3: 0Total_Contact_Hours_4: 0Total_Contact_Hours_5: 0Total_Contact_Hours_6: 0Total_Contact_Hours_7: 0Total_Contact_Hours_8: 0Total_Contact_Hours_9: 0Total_Contact_Hours_10: 0Total_Contact_Hours_11: 0Total_Contact_Hours_12: 0Total_Contact_Hours_13: 0Total_Contact_Hours_14: 0Total_Contact_Hours_15: 0Total_Contact_Hours_16: 0Total_Contact_Hours_17: 0Total_Contact_Hours_18: 0Total_Contact_Hours_19: 0Total_Contact_Hours_20: 0Other_Teaching_Hours_1: Other_Teaching_Hours_2: Other_Teaching_Hours_3: Other_Teaching_Hours_4: Other_Teaching_Hours_5: Other_Teaching_Hours_6: Other_Teaching_Hours_7: Other_Teaching_Hours_8: Other_Teaching_Hours_9: Other_Teaching_Hours_10: Other_Teaching_Hours_11: Other_Teaching_Hours_12: Other_Teaching_Hours_13: Other_Teaching_Hours_14: Other_Teaching_Hours_15: Other_Teaching_Hours_16: Other_Teaching_Hours_17: Other_Teaching_Hours_18: Other_Teaching_Hours_19: Other_Teaching_Hours_20: APM_1: APM_2: APM_3: APM_4: APM_5: APM_6: APM_7: APM_8: APM_9: APM_10: APM_11: APM_12: APM_13: Pub_1: Pub_2: Pub_3: Pub_4: Pub_5: Pub_6: Pub_7: Pub_8: Pub_9: Title_Journal_7: Title_Journal_8: Title_Journal_9: Title_Journal_10: Title_Journal_1: Title_Journal_2: Title_Journal_3: Title_Journal_4: Title_Journal_5: Title_Journal_6: Your_Role_1: [First author]Your_Role_2: [First author]Your_Role_3: [First author]Your_Role_4: [First author]Your_Role_5: [First author]Your_Role_6: [First author]Your_Role_7: [First author]Your_Role_8: [First author]Your_Role_9: [First author]Your_Role_10: [First author]Total_IIPPA_NA: OffIIPPA: APM_NA_2: OffAPM_NA_3: OffAPM_NA_1: OffAPM_NA_4: OffAPM_NA_5: OffAPM_NA_6: OffAPM_NA_7: OffAPM_NA_8: OffAPM_NA_9: OffAPM_NA_10: OffAPM_NA_11: OffAPM_NA_12: OffAPM_NA_13: OffPub_NA_1: OffPub_NA_2: OffPub_NA_9: OffPub_NA_3: OffPub_NA_4: OffPub_NA_5: OffPub_NA_6: OffPub_NA_7: OffPub_NA_8: OffPatents_1: Patents_NA_1: OffPatents_2: Patents_NA_2: OffPatents_3: Patents_NA_3: OffPatents_4: Patents_NA_4: OffPatents_5: Patents_NA_5: OffInvited_1: Invited_NA_1: OffInvited_2: Invited_NA_2: OffInvited_4: Invited_3: Invited_5: Invited_NA_3: OffInvited_NA_4: OffInvited_NA_5: OffHonors_1: Honors_2: Honors_3: Honors_4: Honors_NA_1: OffHonors_NA_2: OffHonors_NA_3: OffHonors_NA_4: OffService_1: Service_2: Service_3: Service_4: Service_NA_1: OffService_NA_2: OffService_NA_3: OffService_NA_4: OffHonors: OffCertified: OffAdded Qualifications: OffSubmitted, Pending, Title 1: Submitted, Pending, Title 2: Submitted, Pending, Title 3: Submitted, Pending, Title 4: Submitted, Pending, Title 5: Submitted, Pending, Title 6: Submitted, Pending, Title 7: Submitted, Pending, Title 8: Submitted, Pending, Title 9: Submitted, Pending, Title 10: S & P, Funding Agency 1: S & P, Funding Agency 2: S & P, Funding Agency 3: S & P, Funding Agency 4: S & P, Funding Agency 5: S & P, Funding Agency 6: S & P, Funding Agency 7: S & P, Funding Agency 8: S & P, Funding Agency 9: S & P, Funding Agency 10: S & P, Your Role 1: [PI]S & P, Your Role 2: [PI]S & P, Your Role 3: [PI]S & P, Your Role 4: [PI]S & P, Your Role 5: [PI]S & P, Your Role 7: [PI]S & P, Your Role 6: [PI]S & P, Your Role 8: [PI]S & P, Your Role 9: [PI]S & P, Your Role 10: [PI]S&P, Costs 1: S&P, Your % Effort 1: S&P, Your % Effort 2: S&P, Your % Effort 3: S&P, Your % Effort 4: S&P, Your % Effort 5: S&P, Your % Effort 6: S&P, Your % Effort 7: S&P, Your % Effort 8: S&P, Your % Effort 9: S&P, Costs 2: S&P, Costs 3: S&P, Costs 4: S&P, Costs 5: S&P, Costs 6: S&P, Costs 7: S&P, Costs 8: S&P, Costs 9: S&P, Costs 10: S&P, Plus 10: Comments_Additional_S&P: Submitted, Not Funded, 1: Submitted, Not Funded, 2: Submitted, Not Funded, 3: Submitted, Not Funded, 4: Submitted, Not Funded, 5: Submitted, Not Funded, 6: Submitted, Not Funded, 7: Submitted, Not Funded, 8: Submitted, Not Funded, 9: Submitted, Not Funded, 10: S & NF, Funding Agency, 1: S & NF, Funding Agency, 2: S & NF, Funding Agency, 3: S & NF, Funding Agency, 4: S & NF, Funding Agency, 5: S & NF, Funding Agency, 6: S & NF, Funding Agency, 7: S & NF, Funding Agency, 8: S & NF, Funding Agency, 9: S & NF, Funding Agency, 10: S&NF, Your_Role_1: [PI]S&NF, Your_Role_2: [PI]S&NF, Your_Role_3: [PI]S&NF, Your_Role_4: [PI]S&NF, Your_Role_5: [PI]S&NF, Your_Role_6: [PI]S&NF, Your_Role_7: [PI]S&NF, Your_Role_8: [PI]S&NF, Your_Role_9: [PI]S&NF, Your_Role_10: [PI]S&P, Your % Effort 10: S&NF, Your % Effort 1: S&NF, Your % Effort 2: S&NF, Your % Effort 3: S&NF, Your % Effort 4: S&NF, Your % Effort 5: S&NF, Your % Effort 6: S&NF, Your % Effort 7: S&NF, Your % Effort 8: S&NF, Your % Effort 9: S&NF, Your % Effort 10: S&NF, Costs 1: S&NF, Costs 2: S&NF, Costs 3: S&NF, Costs 4: S&NF, Costs 5: S&NF, Costs 6: S&NF, Costs 7: S&NF, Costs 8: S&NF, Costs 9: S&NF, Costs 10: S&NF, Score 2: S&NF, Score 3: S&NF, Score 4: S&NF, Score 5: S&NF, Score 6: S&NF, Score 7: S&NF, Score 8: S&NF, Score 9: S&NF, Score 10: S&NF, Score 1: S&NF, Percentile 1: S&NF, Percentile 2: S&NF, Percentile 3: S&NF, Percentile 4: S&NF, Percentile 5: S&NF, Percentile 6: S&NF, Percentile 7: S&NF, Percentile 8: S&NF, Percentile 9: S&NF, Percentile 10: Current, Not Funded, 1: Current, Not Funded, 2: Current, Not Funded, 3: Current, Not Funded, 4: Current, Not Funded, 5: Current, Not Funded, 6: Current, Not Funded, 7: Current, Not Funded, 8: Current, Not Funded, 9: Current, Not Funded, 10: C&NF, Your_Role_1: [PI]C&NF, Your_Role_2: [PI]C&NF, Your_Role_3: [PI]C&NF, Your_Role_4: [PI]C&NF, Your_Role_5: [PI]C&NF, Your_Role_6: [PI]C&NF, Your_Role_7: [PI]C&NF, Your_Role_8: [PI]C&NF, Your_Role_9: [PI]C&NF, Your_Role_10: [PI]C&NF, Your_Effort_1: C&NF, Your_Effort_2: C&NF, Your_Effort_3: C&NF, Your_Effort_4: C&NF, Your_Effort_5: C&NF, Your_Effort_6: C&NF, Your_Effort_7: C&NF, Your_Effort_8: C&NF, Your_Effort_9: C&NF, Your_Effort_10: S&NF, Plus 10: Comments_Additional_S&NF: C&NF_Plus 10: Comments_Additional_C&NF: Other_Accomplishments: Issue_1: Issue_2: Issue_3: Issue_4: Teaching_Chair_Feedback: Service_Chair_Feedback: Patient_Care_Chair_Feedback: Research-Scholarship_Chair_Feedback: Admin_Chair_Feedback: Other_Chair_Feedback: Long-Term_Goals_Chair_Feedback: Time_in_Minutes: Form_Suggestions: Division: OffFaculty Rank: OffAppointment Series: OffDiscovery: Education: Application: Long-Term_Goal_1: Long-Term_Goal_2: Long-Term_Goal_3: Long-Term_Goal_4: Long-Term_Goal_5: Needs_Long-Term_Goals: Total_Other_Teaching_Hours: 0Total_Contact_Hours: 0First Name: Middle Name: Last Name: Email: %_Effort_Teaching_2014: %_Effort_Teaching_2015: %_Effort_Service_2014: %_Effort_Patient_Care_2014: %_Effort_Research-Scholarship_2014: %_Effort_Admin_2014: %_Effort_Total_2014: 0%_Effort_Service_2015: %_Effort_Patient_Care_2015: %_Effort_Research-Scholarship_2015: %_Effort_Admin_2015: %_Effort_Total_2015: 0Teaching_Accomplishments_2014: Teaching_Challenges_2014: Teaching_Goals_2015: Service_Accomplishments_2014: Service_Challenges_2014: Service_Goals_2015: Patient_Care_Accomplishments_2014: Patient_Care_Challenges_2014: Patient_Care_Goals_2015: Research-Scholarship_Accomplishments_2014: Research-Scholarship_Challenges_2014: Research-Scholarship_Goals_2015: Administration_Accomplishments_2014: Administration_Challenges_2014: Administration_Goals_2015: Other_Accomplishments_2014: Other_Challenges_2014: Other_Goals_2015: Needs_Goals_2015: Continued_Feedback_2015: