ࡱ> AC>?@@ 0bjbjצצ XB%$BVVVPV<6XB~2>[*hb"bbbb0d$e|y{{{{{{$Rhbbhhbb8mmmhbbymhymmrmvTmwb2[ ..Vnivy N0~vʉjʉmwBBʉmwHejfmftng`eeeBB5&:lXBB&:University of Pennsylvania School of Medicine Office of Faculty Affairs & Professional Development University of Pennsylvania School of Medicine EXTENSION Request for: Academic Support Staff Research Associate, Instructor A , and Lecturer A Three year term limit positions According to the Faculty Handbook policy, these positions have 3-year term limits. Full time service in these positions may not exceed three years, except with approval of the Provost and PSC minutes. See policy at  HYPERLINK "http://www.upenn.edu/assoc-provost/handbook/ii_b_4.html" http://www.upenn.edu/assoc-provost/handbook/ii_b_4.html Extension Request Prepared by Department Submit Request 6 months before the End Date of the 3-year term limit Fill in Section A of Page 2 and all of Page 3. Attach visa documentation, if applicable Attach the candidates CV & Grants Send the extension request with attachments to the attention of: Karen Grasse Associate Director FAPD Office 328 Anatomy Chemistry/6015 Signatures and Approval FAPD Review Vice Dean for Administration & Finance s Signature (for salary and funding approval) Dean s Signature Provost s Staff Conference (PSC) ( to be minuted) Revised: 2.1.2006 Candidate Name: FORMTEXT      Degree: FORMTEXT    University of Pennsylvania School of Medicine Extension Request for Academic Support Staff -- Research Associate, Instructor A , Lecturer A Extension Approval Page A. Department: FORMTEXT       Position: FORMTEXT      Visa  FORMTEXT       Extension Start Date: FORMTEXT   / FORMTEXT   / FORMTEXT      Extension End Date: FORMTEXT   / FORMTEXT   / FORMTEXT     Contact: FORMTEXT      Phone #:( FORMTEXT    )  FORMTEXT     -  FORMTEXT      FORMCHECKBOX Approved in FY FORMTEXT     BudgetReason for Extension Request  FORMTEXT       Signature:   FORMTEXT   / FORMTEXT   / FORMTEXT     Department BA Signature:   FORMTEXT   / FORMTEXT   / FORMTEXT     Chair of Department (date) Signature:  FORMTEXT   / FORMTEXT   / FORMTEXT      Principal Investigator (date)  For FAPD & Dean s Office Use Only: B. FAPD Review : FORMCHECKBOX reviewed Comments: FORMTEXT       Signature:   FORMTEXT   / FORMTEXT   / FORMTEXT     FAPD Reviewer (date) C. SOM Finance Review : FORMCHECKBOX approved FORMCHECKBOX not approved Comments: FORMTEXT        Signature:   FORMTEXT   / FORMTEXT   / FORMTEXT     Vice Dean for Administration and Finance(date) D. Dean s Review : FORMCHECKBOX approved FORMCHECKBOX not approved Comments: FORMTEXT        Signature:   FORMTEXT   / FORMTEXT   / FORMTEXT     Executive Vice President /Dean(date) E. Submitted to PSC  FORMTEXT   / FORMTEXT   / FORMTEXT     (date) Candidate Name: FORMTEXT      Degree: FORMTEXT      University of Pennsylvania School of Medicine Extension Request for Academic Support Staff -- Research Associate, Instructor A , Lecturer A Proposed Salary and Salary Sources PROPOSED SALARY AND SALARY SOURCES Proposed Compensation during Extension Period$ FORMTEXT       Anticipated sources of salary & employee benefit support:Source:SalaryEBsTotalEVP / Dean s funds (000000) FORMTEXT       FORMTEXT       FORMTEXT      ADF (014004) F#-2ghkùzhVhD2#h'!eh4>*CJOJQJ^JaJ#h'!eh2>*CJOJQJ^JaJ#h'!eh25CJOJQJ^JaJ#h'!eh=5CJOJQJ^JaJ#h'!ehu5CJOJQJ^JaJ#h'!ehR;>5CJOJQJ^JaJh5CJOJQJ^JaJhhOJQJhCJOJQJh:CJOJQJh5:CJOJQJh5CJOJQJh^!5:CJOJQJh5:CJOJQJh h```[[$a$$a$gdR;> D%)&#$./]gd  D%)d&#$./]gd& D%)&#$&d./P]gd &#$./]gd L&#$./]Lgd . 0 A G > ? @ w x y z { ʵʊp\H4&h'!eh25CJOJQJ\^JaJ&h'!eh 5CJOJQJ\^JaJ'h'!eh+q0JCJOJQJ\^JaJ2jhihhCJOJQJU\^JaJ,jh'!eh+qCJOJQJU\^JaJ&h'!eh+qCJOJQJ\]^JaJ)h'!eh+q6CJOJQJ\]^JaJ#h'!eh+qCJOJQJ\^JaJ h'!eh2CJOJQJ^JaJ#h'!eh2>*CJOJQJ^JaJ  s y z {  F j k l gd5ZP & F P^`gd{ K8^8gd  & F `gd ^gd+q   j k l ɸwfU@,&h'!eh25CJOJQJ\^JaJ)h'!eh25>*CJOJQJ\^JaJ h'!eh'!eCJOJQJ^JaJ h'!eh2CJOJQJ^JaJ h'!eh{ KCJOJQJ^JaJ h'!ehDCJOJQJ^JaJh-\CJOJQJ^JaJ h'!ehgCJOJQJ^JaJ h'!eh CJOJQJ^JaJ#h'!eh25CJOJQJ^JaJ#h'!ehq45CJOJQJ^JaJ#h'!eh 5CJOJQJ^JaJ $ & > . ȷsaO>-ڕ h'!eh00dCJOJQJ^JaJ h'!eh+qCJOJQJ^JaJ#h'!eh00d>*CJOJQJ^JaJ#h'!eh+q>*CJOJQJ^JaJ h'!ehK6CJOJQJ^JaJ h'!eh'!eCJOJQJ^JaJ h'!eh2CJOJQJ^JaJ h'!eh.CJOJQJ^JaJ h'!ehoCJOJQJ^JaJ#h'!eho>*CJOJQJ^JaJ#h'!eh2>*CJOJQJ^JaJ&h'!ehK65CJOJQJ\^JaJ & > p r  pl$IfgdTc pl$If`gdTcgdTcP & F 8P^` & F 8P^`gd00dgdO. @ J L P l n p r ˺˺p\N@2.hTchTcCJOJQJ^JaJh=_CJOJQJ^JaJh3GCJOJQJ^JaJ&hgh256CJOJQJ^JaJ&hghg56CJOJQJ^JaJ&hghQ0R56CJOJQJ^JaJ h%h-CJOJQJ^JaJ h'!eh2CJOJQJ^JaJ h'!ehCJOJQJ^JaJ h'!eh;ACJOJQJ^JaJ h'!eh !CJOJQJ^JaJ#h'!eh;A>*CJOJQJ^JaJ  "$&<>npͺإ͒إyldYdYOlhTchTc5\ *h?hTc5\ *hTc5\hTc>*OJQJ\^JhwhTc\!hBhhTc5>*OJQJ\^J$jW *hBhhTc5U\)j *hBhhTc5U\mHnHu$j *hBhhTc5U\ *hBhhTc5\j *hBhhTc5U\hBhhTc5\hBhhTc5CJ\aJ "$K7 pl$IfgdTckd$$Iflr!$  t0`'6844 la$&>n$ pl$Ifa$gdTcgkd$$Ifl%`' t0`'644 lanpr $IfgdTcxgdTcgkd?$$Ifl%`' t0`'644 lapr&ʸգʚtbMtt(jh@hN@CJUaJmHnHu#jh@hN@CJUaJh@hN@CJaJjh@hN@CJUaJh@hN@5CJaJhN@5CJaJ(jh@hTcCJUaJmHnHu#jh@hTcCJUaJh@hTcCJaJjh@hTcCJUaJh@hTc5CJaJh;hTc5CJ\]aJ8qhh__ $IfgdN $IfgdTckd$$IflPF' `' c t0(    44 la&(*46:Jrvx޾xhxXxjh hN@CJUjWh hN@CJUjhN@CJUmHnHujh hN@CJUjhN@CJU hN@CJhThN@5CJaJh@hN@5CJh@hN@CJaJ(jh@hN@CJUaJmHnHujh@hN@CJUaJ#jfh@hN@CJUaJ8:v^UUU $Ifgd@kd$$IflP\'  `' #@  t0(44 laqhhh $Ifgd?kdC$$IflPF' `' c t0(    44 la 0248:<>RTVZ\^`tvxؾή؞ή؎ή؃xiWi#jy h@hN@CJUaJjh@hN@CJUaJhihN@CJaJh@hN@CJaJj h hN@CJUj h hN@CJUjhN@CJUmHnHuj& h hN@CJUjhN@CJU hN@CJhThN@5CJaJhTh&n5CJaJhT5CJaJ JLNPqe\\O\\\ $If^gd? 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Funding Source:  FORMDROPDOWN Candidate s Role in Project: FORMTEXT      Candidate s % Effort:  FORMTEXT      Candidates Salary Support ($): FORMTEXT      Principal Investigator of the support funds: FORMTEXT      Sponsor Name: FORMTEXT      Sponsor Description FORMTEXT      UPenn Account Number ( if existing) FORMTEXT       Funding Source:  FORMDROPDOWN Candidate s Role in Project: FORMTEXT      Candidate s % Effort:  FORMTEXT      Candidates Salary Support ($): FORMTEXT      Principal Investigator of the support funds: FORMTEXT      Sponsor Name: FORMTEXT      Sponsor Description FORMTEXT      UPenn Account Number ( if existing) FORMTEXT       Fill in this section for individual who has clinical activities in their position: How is this position funded ?  FORMTEXT       FORMTEXT       Will this position participate in a clinical practice productivity based compensation plan?  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