2017 Claflin Consultation Initiative: Advisees

DEMOGRAPHICS

Thank you for your interest in the Claflin Consultation Initiative (CCI). This program of the Center for Faculty Development's Office for Women's Careers is designed to help applicants develop a strong application for the Claflin Distinguished Scholar Awards. Through the CCI, you will be matched with a Claflin alumna for advice on your application. Please fill out the information in this survey to help us provide you with the best consultation possible.

Note: If you have questions about your eligibility, please email ecor@mgh.harvard.edu or womens.careers@partners.org.

The Claflin application deadline is Tuesday, October 12, 2016, and the last date to enroll in the CCI is Monday, September 12, 2016.

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* 1. Name

First Name:

Last Name:

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* 2. Degree(s)

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* 3. Current Harvard Medical School rank

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* 4. MGH Department:

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* 5. Number of years at current faculty rank

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* 6. For Assistant Professors, number of years spent at the Instructor rank

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* 7. Have you previously held a faculty position at another institution?

Yes

2017 Claflin Consultation Initiative: Advisees

DEMOGRAPHICS

Question Title

* 1. Name

Question Title

* 2. Degree(s)

Question Title

* 3. Current Harvard Medical School rank

Question Title

* 4. MGH Department:

Question Title

* 5. Number of years at current faculty rank

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* 6. For Assistant Professors, number of years spent at the Instructor rank

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* 7. Have you previously held a faculty position at another institution?

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* 8. If yes, please list institution name, number of years on faculty there, and faculty rank at departure

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* 9. Preferred email address (This will be given to your Claflin alumna match)

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* 10. Preferred phone number (This will be given to your Claflin alumna match)