CON Summer Salary Award Application

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Appendices

UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING
Summer Salary Award Application	Subsection: Appendix F1
Section - Appendices	Originating Date: December 2007
Responsible Reviewing Agency: Executive Council	Revised: January, 2008 Revised: March 2015
Related documents:

Form

Due 5 p.m. – February 25
to Assistant Dean for Approval
Due Monday, 5 p.m. March 3 to Co-Chair of Summer Salary Award Committee

Applicant Name:

Campus and Dept:

(One application per faculty member is necessary,
even if on same Project)

Number of weeks_____ or days_____ being requested. Total weeks for one or more Projects must not exceed 6 weeks. Your application may be approved but recommended for fewer days. Please complete a separate application for each unrelated Project and prioritize them. The Project(s) must be developed by Friday August 8.

Title of Project (with priority number if applying for more than one Project):

Description of the Project:

Proposed Outcome(s)/Product (Be very specific)

Coordination
For faculty working together (either cross campus or on same campus) on the same summer salary Project, include here assignment of essential tasks to each member

Cross Campus: Please indicate whether coordination with cross campus faculty is already arranged (preferred) or plans for doing so - if applicable:

Needed support (technical, additional equipment, etc). Please attach a copy of Technology Services Request work order (or related email) with your request and indicate if you have had a verbal conversation with any of the ITS staff regarding feasibility of completing.

Names of other individuals who are requesting time on this Project and amount of days _______ or weeks _______requested per individual:

List any current or proposed funding associated with the Project:

Rationale for Project
Provide a statement of the need for this Project. Briefly describe in your own words: a) how this Project ties into the summer salary award priorities; and b) how Project fits into the Strategic Plan.

Plans for Demonstration and/or Implementation on Own Campus:

Plans for Demonstration and/or Implementation on Other Campuses:

How the Success or Effectiveness of Project Will Be Evaluated:

Time Line for:

1. Developing each component of the Project (for each member if working together)
2. Implementing on own campus
3. Implementing on other campuses
4. Evaluating the success or effectiveness

Attach Completed Check List for Application Process

Written Report of Completion
If I am awarded a Summer Salary Award, I understand that a written report (using the Summer Salary Award Report Form) describing the Project, the outcomes/product, plans for implementation, and for evaluation will be due Friday September 5 at 5 p.m. to my Division Assistant Dean for her/his approval and then due Friday September 12 by 5 p.m. to the co-chair of the Summer Salary Award Committee to be shared with the Summer Salary Award Committee. I agree to share completed products with other campuses and demonstrate them as applicable.

 

____________________________________________ Signature of Faculty Member Applying Or email from faculty member		_________________ Date
Division Assistant Dean Approval of this Project
__________________________________________ Signature of Division Assistant Dean Or notification of approval by forwarding on email by		_________________________ Date