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Reappointment Adjunct Application

Complete this form to reapply for your adjunct appointment within UNC PM&R. Please complete this form ONLY if you have a current adjunct appointment within UNC PM&R. If you have never had an adjunct appointment within our department, please use the "Initial Adjunct Appointment" 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
  • Summary 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 since being granted your adjunct appointment with UNC PM&R.
  • Please provide number of students, learning topics, and frequency of your teaching. If you did not teach, please write "no."
  • Please provide details of clinical work involved and time spent. If you did not supervise a medical student or resident, please write "no."
  • Please provide name of the research project, other involved faculty members, and time spent. If you did not collaborate on research through grants or papers, write "no."
  • Please provide your consulting details, other involved faculty members, and time spent. If you did not serve as a consultant on a research project, write "no."
  • Written Responses

  • Write a brief statement (3-7 sentences) as to how your UNC PM&R Adjunct Appointment has served you.
  • If granted a reappointment within our department, are there other ways that you plan to engage with our department 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.