EUSOM Evaluator Form for Appointments and Promotions

Evaluator Name:*

Your first name, last name, and credentials

Academic Rank:*

(e.g. Professor, Associate Professor, etc.)

Academic Affiliation:*

(e.g., Emory University)

Email:*

example@example.com

Name of Candidate:*

Date*

Signature*

Please indicate which of these items describes your relationship to the candidate and your knowledge of the candidate's work. Check all that apply and describe any relationship with the candidate in the corresponding boxes below.

Relationship to the candidate and the candidate's work:*

Past or present colleague at the same institution (e.g., as student, fellow, faculty member. This applies only to external evaluators)Past or current mentor or menteePast collaborator on a research projectOther - please describe in the box indicated belowNone of the above

Please elaborate on the nature of your collaboration below: (e.g. shared grants, co-authorship on papers)*

Other - please describe here:*

Knowledge of the candidate's work is based primarily on:*

Candidate's publications and CVScientific presentationsPersonal knowledge and discussionsJoint participation in proffessional actities (e.g. advisory board, study session, etc.)

Indicate any professional and/or personal conflict of interest in the space provided below.

Candidate Reputation: If you were to rank the candidate's stature and overall reputation in your field relative to others at a similar career stage, would you consider the candidate to be in the:*

Based on the provided guidelines, would you support this candidate's proposed appointment/promotion?*

YesNoI have reservations regarding this appointment/promotion.

Please elaborate on your response.*

EXTERNAL EVALUATORS ONLY: Based on your knowledge of the candidate's work and the information provided, would the candidate receive a similar faculty appointment/promotion at your institution?

Please elaborate on your response.

Please upload your official letter of evaluation for the candidate on your institution's letterhead below.*

Emory School of Medicine Evaluator Form for Appointments and Promotions