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Initial Adjunct Appointment Application

Please complete this form to apply for an Adjunct Appointment with UNC PM&R. Only use this form if you have NEVER been appointed before within our department. If you currently have an appointment and wish to reapply for another 2-year term, please use the "Reappointment Adjunct Application" form instead.
  • Applicant Information

  • First, Middle, and Last Legal Names
  • MD, PhD, MS, etc.
  • Medical or other. If none, please write "none."
  • If none, please write "none."
  • Your preferred email address
  • Your preferred phone number
  • Street, City, State, and Postal Code
  • Current Place of Employment
  • Your current job title
  • Street, City, State, and Postal Code
  • Prediction of Contributions to the UNC Department of PM&R

    Below you will find a listing of our department’s meaningful activities. Please document the activities that you have participated in or will participate in if you are granted an adjunct appointment.
  • If you have done this in the past, please provide number of students, learning topics, and frequency. If you plan to do this in the future, please describe your future teaching plans. If you do not plan to teach, please write "no."
  • If you have done this in the past, please provide details of clinical work involved and time spent. If you plan to do this in the future, please describe your future supervision plans. If you do not plan to supervise, please write "no."
  • If you have done this in the past, please provide name of the research project, other involved faculty members, and time spent. If you plan to do this in the future, please provide the name of the research project, other involved faculty, and expected time spent. If you do not plan to collaborate on research through grants or papers, write "no."
  • If you have done this in the past, please provide your consulting details, other involved faculty members, and time spent. If you plan to do this in the future, please provide the consulting details, other involved faculty, and expected time spent. If you do not plan to serve as a consultant on a research project, write "no."
  • Written Responses

  • Write a brief statement (3-5 sentences) as to how your UNC PM&R Adjunct Appointment will serve you.
  • If granted an Adjunct Appointment, are there other ways that you plan to engage with UNC PM&R over the next two years? If so, please describe. If no, please write "none."
  • Please attach a copy of your latest Curriculum Vitae ("CV") completed in the UNC School of Medicine format.