Adjunct Appointment Request

Please use this form to submit Medical School Adjunct Appointment Requests for approval by the Office of Faculty Affairs. All signatures will be collected electronically and returned automatically to the department after final signature. Thank you, and please contact us at ms-ofa@umn.edu or (612) 624-5442 with any questions or concerns.

 

(Email of the person submitting this form)

 

All Appointment Requests will be returned automatically to the email listed below after final signature.

 
 
 

Please separate degrees by a comma. Ex: MD, MPH, PhD

 
 

Primary Practice Site

 
 
 
mm/dd/yyyy
 
 

If there are missing required documents, the adjunct appointment request will not be processed.


Required: Adjunct Appointment Request Memo - Curriculum Vitae (CV) - Adjunct Appointment Letter - Additional Materials (Optional)

Drop your files here