Clinical Reappointment

Reappointment Application

Required *

First Name *

Last Name *

Current Address *

Phone *

Email (for dept use only, will not be shared) *

Current Rank *

Curriculum Vitae

Board Certification

I agree to spend 60 hours of each calendar year in formal teaching activities: *

Use CTRL + click to select multiple activities

This time will be spent in the following teaching activities (select all that apply):

Over the last THREE years, I have participated in the following teaching activities in the Department of Medicine (check all that apply):

Please provide the number of hours (or any additional information) for the activities you indicated above.

Please follow this format:

Number from List Above. Title (if applicable), Number of Hours, and Additional Information.

For example:

4. Clinical Skills Preceptor, 30 Hours, Student Names: Elizabeth Farr, Laura Hsu, Ryder Onopa, Keane Young

5. PBL Tutor, 40 Hours

7. Medical Team Care Attending at Queen's Medical Center, 65 Hours, etc.

Hours and details for the activities listed above:

I have participated in the following community service:

I have read the guidelines for appointment and wish to remain a member of the Clinical Faculty: *

Questions?

If you have any questions, please don't hesitate to call Julieta Rajlevsky at 808-586-7478 or email her at jlrajlev@hawaii.edu.

Also, you can leave any comments you have here:

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