This form is intended to collect information to create or update a faculty member’s academic profile.

Please make sure to fill out the required fields before saving or submitting. You do not have to complete the form all at once. If you select "save draft," simply return to this page within 30 days to complete and submit the form.

If you have any questions, please contact

Faculty Academic Information

Is faculty member a clinician?
"Clinician" indicates that the faculty member treats patients.