TSP Application Form

TSP Application Form

Use this form to apply for the Teaching Scholars Program by the deadline of March 3 of the current academic year. For application instructions, see the TSP website.

For questions, contact Raquel Rodriguez (raquel.rodriguez@ucsf.edu) or Jen Dick (jennifer.dick@ucsf.edu).

Personal Information

First Name*

Preferred First Name (if different)

Last Name*

Degrees*

Email*

Phone*

Work Address/Box No.*

Primary Work Site*

East Bay

Fresno

Mt Zion

Mission Bay

Parnassus

UC Merced

VAMC

ZSFG

Other

Gender

Race and/or Ethnicity

UCSF School/Dept*

Select or enter value

My Teaching Settings

What type of learners do you teach? Select all that apply.*

Select

Academic Rank*

Instructor

Assistant Professor

Associate Professor

Professor

Other

Start date of original UCSF appointment*

If you don't know the exact day, choose the first day of the month.

Departmental Support

This section is to let us know who will support your application and can approve release time. We will send a simple online attestation form for the person to complete in lieu of a letter. See instructions: http://tiny.ucsf.edu/TSPLoS

Department Chair or Division Chief Email*

Alternate Departmental Leader Email

Please provide the email of a departmental leader (if other than your chair) that we should contact.

Attach and Submit

File Attachments*

Please assemble TSP Application Statement and CV into one pdf and upload. Upload limit is 30 MB.

Drag and drop files here or

Application (Goals) Statement

I am attaching a TSP Application Statement document with my application, and I have reviewed the instructions.

I am attaching my CV with my application. The CV is in UCSF Format.

Yes

Contact for Departmental Support

I am providing the name of a departmental leader who supports my application, and I have reviewed the instructions, http://tiny.ucsf.edu/TSPLoS

Send me a copy of my responses

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