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Office of the EVD/CSO - Preliminary Proposal for Faculty Recruitment on the Tenure and Clinician-Educator Tracks

The following information is requested for review by the Office of the Executive Vice Dean and Chief Scientific Officer. Please complete this form for tenure track and clinician educator* track appointments. Please respond "N/A" for any items you are presently unable to answer. Approval must be obtained for all tenure track appointments before proceeding with any written offer.

Please contact evdcso@pennmedicine.upenn.edu with any questions or concerns.

Department

* must provide value

Departmental Contact Name

* must provide value

Departmental Contact Email

* must provide value

Candidate Name

* must provide value

Candidate Current Institution

* must provide value

Candidate Current Position

* must provide value

Proposed Faculty Rank

* must provide value

Proposed Faculty Track

* must provide value

Is this a track change?

Yes

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Track Change Justification

* must provide value

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Advertisement Posted or Search Waiver Requested. Please include the date posted and URL to the ad.

* must provide value

Please upload the candidate's CV.

* must provide value

Upload file

Please upload the candidate's grant page(s).

* must provide value

Upload file

Desired Start Date

* must provide value

M-D-Y

Expected Start Date

* must provide value

M-D-Y

*Space Requirements Section*

Have you identified space within your department's existing footprint?

* must provide value

Yes

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Please detail the space requested in the section below.

Number of Offices (Faculty Recruits Only)

* must provide value

Number of Desks/Workstations

* must provide value

Number of Lab Benches

* must provide value

Preferred location(s), if known

Proposed Building

* must provide value

Please specify if "Other"

* must provide value

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Floor/Room Number(s)

* must provide value

Special equipment and/or procedure space

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Please note special equipment, procedure space and/or anticipated renovation needs

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*Research Requirements Section*

Type of Research

* must provide value

Basic Science

Clinical

Translational

Other

Please specify

* must provide value

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Any Special Requirements for Clinical Research (i.e. clinician research equipment, clinical space, data storage, transfer agreements, material/regulatory transfer, etc.)

* must provide value

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Is the candidate transferring a clinical research program to Penn?

* must provide value

*Associated Clincial Research Staff Section*

Number of Regulatory Staff

* must provide value

Number of Project Managers

* must provide value

Number of CRCs

* must provide value

Other

* must provide value

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*Animal Requirements Section*

Have the candidate's animal research needs been discussed with the Associate Dean for Animal Research?

* must provide value

Type of Animal

* must provide value

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General Housing Needs (i.e. approximate number of large animals or rodent cages housed at any one time)

* must provide value

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Special Housing and Procedure Needs (i.e. ABSL-2, special light cycles, specialized equipment needed in the vivarium or that animals need to be brought to)

* must provide value

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*Research Core Facilities Section*

Would you like to connect the candidate with any of our research core facilities?

Yes

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Please indicate the core faciliteis you would like to connect with your candidate.

Acute Care Biobanking Core

Animal Biosafety Level 3 Core Facility (ABSL-3)

Animal Model Core

Bioinformatics Core

Biostatistics Analysis Center

Brain Science Service Center

CDB Microscopy Core

Cell and Animal Radiation Core (CARC)

Cell Center Services Facility

Cell Center Stockroom

Center for Advanced Computer Tomography Imaging Services (CACTIS)

Center for Advanced Metabolic Imaging in Precision Medicine (CAMIPM)

Center for Advanced MRI and Spectrometry (CAMRIS)

Center for Biomedical Image Computing & Analytics (CBICA)

Center for BioMedical Informatics Core

Center for Host Microbial Interactions

Center for Human Phenomic Science (CHPS)

Center for Preventive Ophthalmology & Biostatistics (CPOB) Biostatistical Consulting

CFAR Virus & Reservoirs Core

Chemical and Nanoparticle Synthesis Core (CNSC)

Clinical Imaging Core Service Center

Clinical Research Computing Unit (CRCU)

Cluster for Biomedical Image Computing (CUBIC)

Community Engagement & Research (CEAR)

Comparative Pathology Core

Cooperative Human Tissue Network (CHTN)

CRISPR Cas9 Mouse Targeting Core

DRC Radioimmunoassay and Biomarkers Core Facility

Electron Microscopy Resource Lab

Electronic Phenotyping Resource

Engineered mRNA and Targeted Nanomedicine Core

Extracellular Vesicle (EV) Core Facility

Flow Cytometry Core

High-Throughput Screening Core (HTSC)

Host-Microbial Analytic and Repository Core (H-MARC)

Human Immunology Core (HIC)

Human Intervention Core

IBI Clinical Research Informatics Core

IFI CyTOF Service Center

Imaging Core

Immune Health Platforms

Induced Pluripotent Stem Cell Facility

Islet Cell Biology

ITMAT Bioinformatics Facility

ITMAT Study Design & Biostatistics Core (SDAB)

Johnson Foundation Biophysical and Structural Biology Core (JFBSB)

LDI Health Economics Data Analyst Pool (HEDAP)

LDI Health Services Research Data Center (HSRDC)

Live Cell Imaging Core

Metabolomics Core

Microbial Culture & Metabolomics Core

MINS Machine Shop

Mixed Methods Research Lab (MMRL)

Molecular Pathology and Imaging Core (MPIC)

Muscle Physiology Assessment Core

Neurobehavior Testing Core (NTC)

Neuroimaging and Cognitive Core

Neurons R Us (NRU)

Nuclear Medicine Physics & Instrumentation Group

OCRC Tumor BioTrust Collection

Penn Cytomics: Flow Cytometry and Cell Sorting Core Facility

Penn Electronic Design Shop

Penn Genomic and Sequencing Core: DNA Sequencing Facility

Penn Genomic and Sequencing Core: Molecular Profiling Facility

Penn Genomic and Sequencing Core: Next Generation Sequencing Core (NGSC)

Penn Gnotobiotic Mouse Facility

Penn Medicine Biobank

PET Center

Proteomics Core Facility

Referral Center for Animal Models of Human Genetic Disease

Research Instrumentation Shop (RIS)

Rodent Cardiovascular Phenotyping Core

Rodent Metabolic Phenotyping Core (RMPC)

Small Animal Imaging Facility (SAIF)

Stem Cell and Xenograft Core

Targeting Core

Tissue Processing Core

Transgenic and Chimeric Mouse Facility

Transgenic Mouse Core

Tumor Tissue/Biospecimen Bank (TTAB)

Ultrasound Research Laboratory

Vector Core

Viral Molecular High Density Sequencing Core Facility

Other

Please specify if "Other."

* must provide value

*IT Requirements Section*

Have the candidate's technology research needs been discussed with PMACS (DART) / Penn Medicine Information Services?

* must provide value

Will the candidate be generating, analyzing, transferring, and/or storing more than 5 TB of data?

* must provide value

Will the candidate be transferring data and/or computing equipment from their prior institution?

* must provide value

Is any of the candidate's data, presently or in the future, subject to regulatory or other contractual requirements (i.e. data use agreements, HIPAA)?

* must provide value

Are there any other technology requirements for this faculty member beyond current standards? Examples may include network connections faster than 1 Gbps, servers and data storage equipment that will be stored outside Penn Medicine data centers. Please describe.

* must provide value

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*Grants and Contracts Section*

Does the recruit have grants and contracts that will be transferred? Please provide funding agency.

* must provide value

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If recruit is transferring grants, are there animal/human subject protocols associated with any grants that are to be transferred?

* must provide value

Outside Activities (relative to proposed position at Penn)

Does the recruit have any financial arrangements or interests that might reasonably be judged to constitute a potential conflict of interest with his/her proposed Penn position, or which we should be aware of before finalizing recruitment?

* must provide value

Board Positions (Company and Role)

* must provide value

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Companies Owned (Company Name and Role)

* must provide value

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IP/Patents and Licenses

* must provide value

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Associated Faculty Recruitment(s)

Please provide rank and track

* must provide value

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*Associated Lab Staff/Personnel Section*

Number of Post Docs

* must provide value

Number of Techs

* must provide value

Number of Students

* must provide value

Number of Administrative Staff

* must provide value

Other

* must provide value

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Total Start-up Offer and Sources of Funding

* must provide value

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Any Additional Comments

* must provide value

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*This form is strongly recommended for all clinician educator (CE) track candidates requiring support in any or all of the following areas: space, clinical research resources, animal resources, IT resources, grant/contract support. For CE track candidates who do not require support in any of these areas, please feel free to utilize this form as helpful.

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