Create a Request Ticket
Please complete this form and one of our agents will reply to you by email as soon as possible.
I understand that the process of recovering previous years’ lecture recordings is a process that may require outsourcing. This process may take on average 5 business days.
I understand that the process of censoring videos for FERPA protected information is the responsibility of the course director.
Please enter your name in the box below to acknowledge these conditions:
I understand that the process of publishing video recordings to may take up to 3 business days.
I understand that the process of censoring videos for FERPA protected information is the responsibility of the course director.
Please enter your name in the box below to acknowledge these conditions:
Formal understanding of the process or terms of the agreement if faculty request to no longer be in joint position and asks to be assigned to only one unit rather than how originally hired
Instructions: Please use this form to request approval to establish a new faculty position or to fill a faculty position that has been vacated. This form is applicable to all faculty positions with the exception of compensated research faculty, post-doctoral fellows and research associates. Please use the COM Research Faculty or Post-Doctoral Fellow Position Request form for those positions. Authorization from the Dean and Provost’s Office is necessary before recruiting or advertising faculty positions with benefits.
In the Subject field below, enter the job title.
In the Subject field below, enter the job title.
Which Departments/Colleges/Pillars/Platforms will support this joint-hire?
What is the specific assignment for the last incumbent and how will that be different for the new hire?
Please select what type of appointment is requested for this position.
If posted, this will display to applicants.
Will this position have benefits?
Please select one of the following:
Please specify the anticipated end date
Please select which rank is being requested?
Please Specify:
If this is a visiting position, what is the anticipated end date?
11. In the boxes below, please describe what are the responsibilities for this position? Specify unit. If not applicable, type N/A.
Type of (specific) courses and other teaching responsibilities, e.g., courses to be taught, medical education, graduate medical education, graduate education, thesis or dissertation, advising, etc.
Expectations for scholarly activity, including expectations for extramural grant or contract funding, etc.
Expectations for service to the department, college, university, profession, community, etc.
Percentage of time to be assigned for clinical service, type and location of clinical service, etc.
Assigned administrative responsibilities and title, e.g., assistant/associate program director, clinical education director, residency program director, etc
12. Percentage of effort: In the boxes below, indicate the expected percentage of effort in each area (teaching, research, service, clinical service, administration) in each unit for first year and subsequent years.
If this position provides clinical service, when do the clinical duties start and what arrangements have been made or will need to be made?
What is the market salary range for this position? Important: If a salary is proposed for the final candidate which is above what was originally submitted to and approved by the Dean and Provost, the department must prepare a Request to Adjust the Salary Range (to be approved by the Dean and Provost). Indicate Salary Range: Low End -> Upper End
What is the source of information/benchmark used for the requested salary range?
Is the requested position already budgeted?
Please specify Amount $, TAG# and for vacant positions, Position # and Person being replaced.
Please specify Amount $, TAG # and Explanation of funds.
Please specify Amount and TAG #
Please specify Amount $, TAG #, Explain source
Please specify Amount $, TAG #, source of funds.
Please Specify Amount $ and TAG #
Please specify Amount $ and TAG #
Please specify Amount $, TAG #, source of funds.
Please specify the Amount $ and details on additional funds that are being requested.
What start-up costs are anticipated for this position? Include only costs for new equipment, space renovations, support staff and travel costs.
Please list the sources of funds for start-up costs. (Include the source of the funds as well as the Amount $ and TAG # for each source.)
Identify this position’s primary office location, access to instructional support materials, administrative and research support, and/or research space.
Please explain the relevance of this position to the FAU Strategic Plan 2025 and the College of Medicine Strategic Plan.
Who is the direct supervisor of this position (if other than the Chair)?
Will this position require a cell phone?
What is the SmartTag for the background check?
Amount to be reimbursed
If yes, please refer to the Office of the Provost Faculty Search and Hiring Procedures and provide specific exemption justification/criteria.
If a search is not required or requested and a candidate is identified, are there any immigration issues that need to be addressed? If yes, please provide the type of visa being requested.
Please complete items 31-33 only if a search is required or requested.
If this position is not exempt from the recruitment/search process or a search is requested, what is the proposed composition of the search committee (chairperson and committee members)? Note: The search committee must include diverse (race and gender) representation. Department coordinators should include their name on the search committee so they may view candidate information.
If a search is required or requested, attach the posting in Word. This posting verbiage will be displayed to applicants. Important: Once this information is submitted via the job requisition, the information cannot be changed unless the entire action is canceled and reinitiated.
Is outside advertising requested? If yes, please list specific advertising sources and length of
time to be posted. Note: advertising in on-line publications and publications that enhance diversity is encouraged. The Senior Associate Dean for Finance must approve all advertising costs before placement.
time to be posted. Note: advertising in on-line publications and publications that enhance diversity is encouraged. The Senior Associate Dean for Finance must approve all advertising costs before placement.
Please complete items 34-39 if this is a Joint hire .
Explain how the evaluation and review will be conducted for the following, as applicable: Annual Review, Third-year Review, Promotion and Tenure, etc., according to the Faculty Handbook; salary increases from Change in Employee Compensation/other. Include information regarding Employee’s primary academic discipline and voting rights in each department, consistent with college and departmental bylaws.
36. Departments and Pillars will share grant-based salary recovery and IDC distribution based on percent pay covered by the Department and Pillar. Please specify the percentage below.
Please enter percentage
Please enter percentage
Please enter percentage
37. Please indicate budgetary designations. Departments and Pillars will share IP revenue based on percent pay covered by the Department and Pillar. Please specify the percentage below.
Please enter percentage
Please enter percentage
Please enter percentage
Please describe conflict resolution procedures for this position.
39. List any other terms/conditions as set by the units on joint-hire for each of the items below.
Formal understanding of the long-term financial resource responsibilities should the faculty member leave the Pillar
Formal understanding of any additional long-term resource responsibilities (other than financial) should the faculty member leave the Pillar
Formal understanding of the terms if the faculty member is granted tenure on appointment or achieves tenure later on (noting that the flow of support may be constrained if the faculty member is out-of-unit)
(if not Requestor)
Please enter any additional information or questions in the box below.
Please give the name you would like for the report
Please provide a brief description of why the report is needed
Provide the date you need this for.
Please list the names of those needed access to this report.
Please include as much information as possible.
Medical (MD) Student
Leave of Absence (LOA) Request FormPolicy information can be found in the Student Handbook
Medical LOA:
If an LOA is granted by the Office of Student Affairs, I understand I must complete the following during the LOA and before a return from the LOA will be approved:
Request Requirements:
Submit sufficient documentation from a licensed healthcare professional stating that he or she recommends a medical leave of absence from medical school.
You are required to confirm your return date by contacting the College of Medicine Office of Student Affairs no later than 90 days before your anticipated return date from your medical leave of absence so that they Office of Medical Education may appropriately plan and coordinate your academic and clinical schedule for your return.
In order to return form a medical LOA, the student is required to submit a letter from your current treating licensed clinical healthcare provider stating within 30 days prior to the anticipated date of your return stating that you are fit to return to medical school and to continue your training to becoming a physician.
Family LOA Requirements-
If an LOA is granted by the Office of Student Affairs, I understand I must complete the following during the LOA and before a return from the LOA will be approved (initial next to the type of LOA you are requesting):
- Student letter outlining current status of family matter(s)
Financial LOA Requirements-
If an LOA is granted by the Office of Student Affairs, I understand I must complete the following during the LOA and before a return from the LOA will be approved:
- Student letter and supporting documentation from Associate Director of Student Financial Aid regarding resolution of financial matters.
Academic Enrichment Requirements-
If an LOA is granted by the Office of Student Affairs, I understand I must complete the following during the LOA and before a return from the LOA will be approved:
- Student must submit a letter stating their intended academic enrichment plan and submit supportive documentation of such plans (description of research or projects in which she or he participated, degree being pursued, or other forms of academic enrichment along with supportive documentation from the relevant institution(s)).
In order to return from an academic enrichment LOA, students must submit proof of participation in such activities.
Academic Enhancement LOA Requirements-
If an LOA is granted by the Office of Student Affairs, I understand I must complete the following during the LOA and before a return from the LOA will be approved:
Student must meet with the Director of Student Success and Wellness to develop a plan to enhance his or her academic performance over the duration of the LOA and submit supportive documentation demonstrating such plan.
Re-take Step 1 Exam LOA-
If an LOA is granted by the Office of Student Affairs, I understand I must complete the following during the LOA and before a return from the LOA will be approved:
- Re-take Step 1 Exam
“Failure and Retaking of Step 1” refer to student handbook (Under USLMLE POLICY)
Other LOA Requirements-
If an LOA is granted by the Office of Student Affairs, I understand I must complete the following during the LOA and before a return from the LOA will be approved:
- Documentation outlined by the Office of Student Affairs when LOA is granted
M1---to be added--
Things student needs to complete in order to return
M2---to be added--
Requirements to complete in order to return
M3--- to be added --
M4-- to be added --
Please read and sign off on the following statements:
- I have met with the Director of Student Financial Aid or Assistant Director of Financial Aid prior to requesting the leave of absence from the College of Medicine.
- I understand that I am required to maintain active health & disability insurance while on a leave of absence.
- I understand that I am required to review and respond, as appropriate, to all email and telephone communications from the Florida Atlantic University Charles E. Schmidt College of Medicine, including during your medical leave of absence.
Room Reservation Request Form (For organizations outside of COM).
For the use of BC-71 (COM) Rooms: 126, 128, 130 and Lobby.
(Room reservation request forms need to be submitted at a minimum of two (2) weeks in advance of event.
(If Applicable)
(If Applicable)
(1) If you are planning to serve alcohol at this event, you, as the requester, is responsible for hiring a professional bartender
(2) A faculty or staff advisor must be present at all student events.
(3) As requester of the room, you acknowledge and accept responsibility for leaving the room clean and orderly at the end of the event. Should there be any damage or room clean-up, COM has permission to charge the TAG that you have provided on this form.
Please type your full name in the box below to indicate that you agree to the terms above.
Black out dates
IMPORTANT: You must check black out dates before proceeding. A list of current black out dates can be found
HERE!
When is your flight out, when are you leaving town, etc.
When are you back in town/ available?
Please provide a reason why your request was not made 4+ weeks in advanced as required.
Please enter the location and actual date of the event
Please select your relationship to the person
Please be advised there is a 4-6 week turn around for all white coat orders. You will receive an email from CoMFacilities when it is ready for pick-up. If you have any questions, please email COMFacilities@health.fau.edu.
Please one: a SHORT coat or LONG coat from the options below:
Once your white coat order request has been approved. You will receive payment instructions. White coat orders will not be placed until payment has been confirmed.
To confirm this order, please type your name in the box below.
To confirm this order, please type your name in the box below.
Please select the option that best fits your needs
Please select the most appropriate Service Type that matches your project/request
Notice: Approval needed from FAU Trademark/Licensing to print sponsor information. See FAU's internal trademark guidelines, as maintained by FAU's Creative Services website here HERE .
Notice: Units work directly with vendors to obtain a quote. Must use an FAU licensed vendor. Licensed vendors are maintained on FAU’s Creative Services website – view the vendor list HERE.
(typically 2 hr. minimum)*
Provide a 280 character description, preferred hashtags, links in the DETAILS box below. (Remember, links and hashtags count towards total character count.)*
Please attach photos in the 2nd box below.
Please attach photos in the 2nd box below.
Please provide the Shot List to be captured in the Details box below.
Attach any floor plans/maps or other relevant documents in the 2nd box below.
Attach any floor plans/maps or other relevant documents in the 2nd box below.
Please provide a script or bullet points for speakers (for virtual and highlight videos only) in the box below.
Attachments can be added in the 2 box below.
Attachments can be added in the 2 box below.
Provide list of recipients or audience. For more than 5 recipients, please upload excel file with recipient information using the 2nd box below.
Content:
Provide article write-up in the Details box below.
Be sure to include as many details as possible, including correct names, titles, etc.
Upload any photos in the second box below.
Provide article write-up in the Details box below.
Be sure to include as many details as possible, including correct names, titles, etc.
Upload any photos in the second box below.
Content Attach the associated file with the logo in the second box below.
For multipage documents, please specify the page number in the DETAILS box below
For multipage documents, please specify the page number in the DETAILS box below
Content:
Please provide content, design ideas an additional information in the Details box below.
Attachments can be included in the 2nd box. To include an email, simply drag the email from your desktop Outlook client into the Attachment Box.
Please provide content, design ideas an additional information in the Details box below.
Attachments can be included in the 2nd box. To include an email, simply drag the email from your desktop Outlook client into the Attachment Box.
Please provide a URL/Link (if applicable) [Event Link/RSVP Link, etc]
Please provide any additional URL/Link (If applicable):
Please list preferred location(s) if to be displayed on Digital Boards
Paper size, resolution size, etc.
Please provide the quantity of items needed. If multiple sizes/styles, please include quantity for each size/style.
Please Select if you would like this mounted on Foam Core
Please specify size (if needed)
Please enter an EXACT DATE. (Format: xx/xx/xx) Any request without an exact date will be discarded.
Please Provide your TAG#
The 2 fields below are for internal use only. Please do not alter them.
Please tell us anything else about the problem, such as the specific error message you received or more details about the issue you experienced in the box below.
Screenshots help us troubleshoot! Please attach any you have in the 2nd box.
Screenshots help us troubleshoot! Please attach any you have in the 2nd box.
Please enter the Job Title in the SUBJECT Field below:
Check all that apply
Please select one or more of the following options:
Please list any special software/hardware or access required in the DETAILS box below. Please include the TAG# that should be used to purchase requested software/hardware.
If none is needed, please indicate "NO SPECIAL SOFTWARE/ACCESS NEEDED"
If none is needed, please indicate "NO SPECIAL SOFTWARE/ACCESS NEEDED"
Please select the SUBMIT button at the end of this page to send your request. Please do not alter any of the fields below this message.