Adjunct Faculty | Center for Faculty Excellence

UAMS Adjunct Faculty Verification Form

The College of Medicine at UAMS values the voluntary service of fully qualified individuals who help achieve our mission. It is the shared responsibility of the Department Chairs and the Dean to determine the specific need of voluntary service. This form is to verify your current adjunct appointment.

Name * Required
First Middle Last Credentials
Rank * Required
College * Required
Department * Required
Division
Start Date
To the best of your knowledge when did you effectively begin serving as an adjunct with UAMS?
MM slash DD slash YYYY
Degree * Required
Last degree received.
Date of birth * Required
MM slash DD slash YYYY
Gender * Required
Race * Required
Preferred Email Address * Required
AR Medical License #: * Required
Board Certified? * Required
- Yes
- No
Preferred Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attestation of adjunct faculty, please check each box showing your agreement to the statements: * Required
- Medical students and faculty will have access to appropriate resources for medical student education
- UAMS College of Medicine is responsible for the medical education program, academic affairs, and assessment of medical students
- UAMS College of Medicine is responsible for the appointment and assignment of faculty members with responsibility for medical student teaching
- In case of student exposure to an infectious or environmental hazard or other occupational injury, treatment and follow-up should follow the UAMS Medical Center policies; and
- I will partner with UAMS College of Medicine to share responsibility for creating and maintaining an appropriate learning environment, conducive to learning and safety.
- I understand that my adjunct faculty appointment requires a minimum of 20 hours of service annually to the AHEC and UAMS College of Medicine. I agree to provide that service and continue my adjunct appointment.
Also please list your annual contributions and note how they support the UAMS missions of teaching, clinical care, and/or research, & also estimate the amount of time spent in each activity. Attach a separate page if needed: * Required

Save and Continue Later

Below is a list of the required documents to submit a request in the JFR for appointing adjunct faculty.

Please review the UAMS College of Medicine Principles for Adjunct Faculty Appointments, available here.

Academic Rank	Required Documents
Adjunct Instructor	· Department Chair letter · Current CV
Adjunct Assistant Professor	· Department Chair letter · Current CV
Adjunct Associate Professor	· Department Chair letter · P & T Letter · Current CV
Adjunct Professor	· Department Chair letter · P & T Letter · Current CV

Contact Katie Poe at khpoe@uams.edu for questions.