School of Medicine Intake Form

School of Medicine Intake Form

This form is used to schedule an affordability meeting for School of Medicine (SoM) Faculty, Clinician Educators, Executive Staff, and Recruits. The affordability meeting lasts approximately one-hour and is held in-person or on Zoom with a Faculty Staff Housing (FSH) team member.

The information is required and used to determine eligibility and run affordability models during the meeting. Once the information is received, a FSH staff member will reach out via email to schedule a meeting. Please note we are booking out approximately two weeks due to a high volume of requests.

Please select your affiliation*

If you are a current Clinician Educator, University Tenure Line, or University Medical Line faculty member select "Active Employee (with SUID)."

If you are an internal recruit, select "Internal Recruit."

If you are a Recruit, select "Recruit."

If you are a SoM Administrator filling this form out on behalf of a current faculty member, employee, or recruit select "SoM Administrator."

Select or enter value

Stanford Admin Full Name*

Please Enter your first and last name.

Stanford Administrator Email*

Please enter your Stanford email address.

Select the affiliate

Please select the affiliate type you are submitting this form on behalf of

Faculty, CE, Staff, or Recruit's First Name*

Please enter the first name of the Faculty, CE, Staff, or Recruit that you are submitting this form on behalf of.

Faculty, CE, Staff, or Recruit's Last Name*

Please enter the last name of the Staff, Faculty, or Recruit that you are submitting this form on behalf of.

Faculty, CE, Staff, or Recruit's Email Address*

Please enter the full email address of the Faculty, CE, Staff or Recruit. For current Faculty, CE, or Staff please use their @stanford.edu email address.

Faculty, CE, Staff, or Recruit's Phone Number*

Please enter the phone number of the Faculty, CE, Staff or Recruit. This information is used in the event there are any technical issues.

Phone

Partner/Spouse Name

Partner/spouse is welcome to join the meeting and any supplemental income information can be provided directly during the meeting. Please provide name if a partner/spouse will be attending the affordability meeting.

School of Medicine Department*

Please select the SoM Department.

Select or enter value

Select Faculty, CE, or Staff*

Please select one of the following options.

Faculty (with SUID)

Clinician Educator (CE with SUID)

Staff (with SUID)

Clinician Educator Line*

Clinical Assistant

Clinical Associate

Clinical Professor

Staff*

Please enter the staff grade level. If unknown, please note we will not be able to schedule an affordability meeting since we cannot determine eligibility status without a Staff grade level. If unknown, active staff members may reach out to their HR representative to obtain their staff grade level.

For information about eligibility, please visit: https://fsh.stanford.edu/buy/eligibility

For more information about salary structure and grade levels, please visit: https://cardinalatwork.stanford.edu/benefits-rewards/compensation/staff-compensation/salary-structure

Faculty*

University Tenure Line (UTL)

Non-Tenure Line (NTL)

University Medical Line (UML)

Faculty UTL Rank*

Please select the University Tenure Line rank.

UTL Assistant

UTL Associate

UTL Professor

Faculty NTL Rank*

Please select the Non-Tenure Line Rank.

NTL Assistant

NTL Associate

NTL Professor

Faculty UML Rank*

Please select the University Medical Line rank.

UML Assistant

UML Associate

UML Professor

Recruit*

Please select the applicable grade or Faculty line of the position the individual is being recruited for.

Select or enter value

Recruit Start Date*

Please enter the tentative start date for the recruit.

All CEs are required to attend a weekly webinar prior to booking an affordability meeting. Please use this link to register for the CE webinar.

By checking the box below, user understands attending a webinar is required before booking an affordability meeting.

Due to a high volume of request for affordability meetings, please note that FSH does not place holds on the calendar.

I understand all CEs must register and attend the webinar before booking an affordability meeting.*

Recruit - CE Line*

Please select the Recruit's Clinician Educator line rank.

Recruit - CE Assistant

Recruit - CE Associate

Recruit - CE Professor

CE's Primary Work Location*

Please enter the primary work location of the Clinician Educator (e.g. Palo Alto, Redwood City, Livermore, etc.).

Recruit - UTL Rank*

UTL Assistant

UTL Associate

UTL Professor

Recruit - NTL Rank*

NTL Assistant

NTL Associate

NTL Professor

Recruit - UML Rank*

UML Assistant

UML Associate

UML Professor

Salary*

Please enter the full salary amount (e.g. 150000). Field is set to accept numbers only and no special characters. Please do not enter "150" to represent 150000. This information is used to run affordability models during the meeting.

FTE Percentage*

Please enter the FTE percentage from 0%-100%.

Incentive*

If applicable, please enter the annual guaranteed incentive (if for 3-years). If not applicable, enter zero ("0").

Please enter the incentive amount (e.g. 15000). Field is set to accept numbers only and no special characters. Please do not enter "15" to represent 15000.

12 Month Admin Support*

If applicable, please enter the 12-month admin supplement amount. If not applicable, enter zero ("0").

Please enter the Admin Support amount (e.g. 15000). Field is set to accept numbers only and no special characters. Please do not enter "15" to represent 15000.

Employment Offer Letter File Upload

If you are unsure of any salary and/or position details, you may upload your employment offer letter here.

Drag and drop files here or

Meeting Preference

If an in-person or Zoom meeting is preferred and/or if there are any preferred meeting date(s)/time(s), please let us know.

Send me a copy of my responses