School of Public Health BMS Faculty Activity Report

Please note:
All fields with * are required. If all required fields are not filled in before selecting the submit button, it may result in having to type the data in all over again.

For the academic year period from June 1, 2006 through May 31, 2007

Name * required: Date:

Department * required:

This report is requested each year as part of the University's comprehensive faculty utilization policy. Because the University's form appears unduly cumbersome for faculty not paid by the University, the School of Public Health has adapted it for our use. We hope it will be simpler for you to complete and that you will take the time to do so.

I. Teaching and Advising

A. Courses: Please list courses you participated in teaching during this academic year and whether you were a course coordinator or gave lectures and how many lectures you gave:

Course # and Name:	Semester	Enrollment	Were you Coordinator?	# lecture hours given

B. Thesis or Dissertation Advisor:
Please indicate student's name, program of study (MS, PhD or MPH) and whether you were the committee chair, a committee member, or other role.

C. Academic Advising:
Please list students' names and programs of study, e.g., MS, MPH, PhD

D. Lab rotation supervisor, field placement mentor, or internship mentor:
Please list students' names, program of study, and nature of mentorship (MS, PhD and MPH students only. Undergraduate students will be listed under Additional External Service).

E. Students financially supported:
Please list students' names and program of study

II. Service to School of Public Health and University

A. Membership in Departmental committees:
Please identify role as Chair or member.

B. Membership in Council or School-wide committees:
Please identify role as Chair or member.

C. Membership in University Councils or committees:
Please identify role as Chair or member.

III. Please estimate annual percent effort spent on School of Public activities.

SPH activities include all teaching activities, including lecture prep; mentoring or advising students; committee service; administrative, governance activities

Annual Percent Effort * required:

Please check the following * required box
and submit an updated CV via email to: bmsdept@wadsworth.org in ADDITION to completing the following sections.

Please enter all relevant information directly into the space provided, and do NOT refer to CV.

IV. Service to Profession * required
(Editorships, editorial boards, national committees, review boards, professional organizations, organizing of conferences)

V. Scholarship * required
(Invited seminars and presentations, grants received, and number of peer-reviewed publications from June 2006 - May 2007)

VI. External Service * required - (Please enter "None" if this is not a relevant category)
(CEPH definition: Service that is an explicit activity undertaken for the benefit of the greater society, over and beyond what is accomplished through teaching and research. ie participation in professional associations; provision of consultation and technical assistance to local community organizations).

VII. Additional Service Activities * required - (Please enter "None" if this is not a relevant category)
Specific examples include hosting undergraduate (including REU) and high school students; hosting high school or college teachers; speaking at Legislative Workshops or Wadsworth Public Lecture Series; or hosting EID or Fogarty Fellows.

VIII. Awards * required - (Please enter "None" if this is not a relevant category)

If you experience any difficulties in submitting this form, please print it out and submit a hard copy with your other material.

If you would like a copy of this information for your records, you may print it AFTER hitting the submit button.

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