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Summary: Revised 5/19/09
University of California, San Diego
Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS)
Proposed Voluntary/Non-Salaried Clinical Faculty Form
Date: ______________________
Proposing SSPPS Faculty Member: _________________________________________________________
Name of Proposed Voluntary/Non-Salaried Faculty: ___________________________________________
Proposed Voluntary/Non-Salaried Faculty E-mail Address: _______________________________________
Proposed Preceptor: Yes No Will be precepting 4th
Year Pharmacy Students: Yes No
Proposed Rank Please Check One:
Clinical Instructor Assistant Clinical Professor Associate Clinical Professor Professor
Proposed Work/Site Location: ___________________________________________________________
Course Title(s): _________________________________________________________________________
Course Number(s): ______________________________________________________________________
The criteria for University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences non-
salaried/voluntary faculty appointment requires that fifty (50) hours of service per academic year are needed for initiating an
appointment. Contributed service by active and direct participation can be met in one or more of the following area(s) as listed
below. Please select the hours of participation or referrals to the teaching program in the column labeled "Estimated Hours."
Item Criteria Description Estimated Hours
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