CON Summer Salary Award Report

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Appendices

UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING
Summer Salary Award Report	Subsection: Appendix F2
Section - Information	Originating Date: December, 2007
Responsible Reviewing Agency: Executive Council	Revised: January, 2008 Revised: March 2015

Form

Submit 1 copy to Division Assistant Dean by 5 p.m. Friday Sept. 5 for signature.

Submit 1 copy, signed or forwarded on email by the Division Assistant Dean to Chairperson of Summer Salary Committee – by 5 p.m. Friday Sept. 12

Name(s):

Division:

[Individuals working together on one project in one course can submit one report with all names]

Title of Project:

Number of approved days ______
Approximate number of days you actually spent completing this project: _________

Outcome (Product)
For each outcome identified on your application or modified by Summer Salary Committee in notification letter, describe if you accomplished it or the progress you made. For tangible outcomes please submit a copy of it. [e.g. if the outcome was to be NCLEX and Blooms’ mapping of test items, then attach the Test Blueprint for the course you did and also indicate how many new test items you developed to achieve the desired relative proportions within the blueprint – For security purposes Do Not Attach Exam Questions; if outcome was to develop a new Sim Man Scenario, attach the printed scenario, list of necessary supplies, and computer print out
Coordination
Cross Campus: Indicate if any coordination with cross campus faculty occurred with their names and campus- if applicable:

Progress Toward Implementation on Own Campus

Progress Toward Demonstration and/or Implementation on All Campuses

Progress Toward Evaluation of the Project

[Note: If implementation and evaluation has not yet been accomplished, a follow-up report will be necessary to Division Assistant Dean].

Additional Support (technical, additional equipment, etc.).
Indicate if additional support was used.
Indicate if additional support was needed, but not available:
Please describe any suggestions for improving the process for summer salary awards:

Please indicate anything else you wish the Summer Salary Committee to know.

____________________________________________		_______________________
Signature of Faculty Member     Or email from faculty member		Date
____________________________________________		_______________________
Signature of Division Assistant Dean     Or notification of approval by forwarding on email		Date