This Version Was Updated 11.17.17

This CV template has been revised to facilitate reviews of portfolios by the Appointments, Promotions and Titles (APT) Committee. We request that the specific information in this template be used for appointment/promotions evaluations, but the format itself is not critical (i.e., do not be concerned with font size, tabulation etc.). Please be consistent and accurate, but style itself is not relevant as long as the needed information is accessible to the Committee.If there are sections that do not apply to you, please feel free to state not applicable (but please leave the heading itself).All CV pages should be numbered with the candidate’s name in the header on each page. The date when the CV was last revised should be provided on the last page. This version was updated 11.17.171 CURRICULUM VITAEDate prepared:NAME:ADDRESS: OFFICEProvide in chronological order or reverse chronological order, but please be consistent.I. EDUCATIONDATES INSTITUTION DEGREEII. POSTDOCTORAL TRAININGDATES INSTITUTION SPECIALTY1 Name: III. PROFESSIONAL DEVELOPMENT ACTIVITIESDATES INSTITUTION TITLE CREDITSIV. ACADEMIC APPOINTMENTSDATES INSTITUTION TITLEV. INSTITUTIONAL LEADERSHIP ROLES:DATES INSTITUTION TITLEVI. LICENSURE AND CERTIFICATION (IF APPLICABLE):DATE LICENSURE/CERTIFICATION2 Name: VII. HOSPITAL APPOINTMENTS (IF APPLICABLE):DATES INSTITUTION POSITION/TITLEVIII. OTHER PROFESSIONAL POSITIONS (NON-DARTMOUTH):DATES INSTITUTION POSITION/TITLEIX. TEACHING ACTIVITIES:METRIC EVALUATIONS AND WRITTEN COURSE REVIEWS MUST BE APPENDED WITH YOUR CV WHEN SUBMITTING YOUR PORTFOLIO FOR REVIEW.FOR COURSES/CLASSES, INCLUDE ONY APPROVED OFFERINGS (I.E., IF FOR DARTMOUTH, THOSE IN THE ORC) AND PROVIDE ONLY YOUR SPECIFIC CONTACT HOURS FOR THAT CLASS.A. UNDERGRADUATE (COLLEGE) EDUCATIONFor each course, please provide the following information: a. Dates course was taught b. Institution c. Course Title d. Your Role e. Hours/Year3 Name: B. GRADUATE EDUCATION List classes taught for Ph.D. or Masters students For each course, please provide the following information: a. Dates course was taught b. Institution c. Course Title d. Your Role e. Hours/YearC. UNDERGRADUATE MEDICAL EDUCATION: i. CLASSROOM TEACHING:For each course, please provide the following information: a. Dates course was taught b. Institution c. Course Title d. Your Role e. Hours/Year ii. CLERKSHIP TEACHINGFor each course, please provide the following information: a. Dates course was taught b. Institution c. Course Title d. Your Role e. Hours/Year4 Name: D. GRADUATE MEDICAL EDUCATION Inclusive of instruction of residents and fellows during clinical practiceFor each course, please provide the following information: a. Dates course was taught b. Institution c. Course Title d. Your Role e. Hours/YearE. OTHER CLINICAL EDUCATION (e.g., PA programs)For each course, please provide the following information: a. Dates course was taught b. Institution c. Course Title d. Your Role e. Hours/YearX. ADVISING/MENTORING Advisees/mentees listed here should be those with whom you have substantive interactions outside of programmatic teaching (clerkships, ORC-listed classes, residencies). Do not include the names of students whom you taught as part of a course (i.e., if you teach first year residents and have listed this teaching above under GME, do not list those students here)A. UNDERGRADUATE STUDENTS e.g., Dartmouth College Arts and Sciences studentsDATES STUDENT’S NAME PROGRAM (e.g., WISP, Presidential Scholar)B. GRADUATE STUDENTSDATES STUDENT’S NAME PROGRAM NAME DEGREE5 Name: C. MEDICAL STUDENTSDATES STUDENT’S NAME PROGRAM NAME (if applicable)D. RESIDENTS/FELLOWSDATES MENTEE’S NAME SPECIALTYE. FACULTYDATES MENTEE’S NAME SPECIALTYXI. RESEARCH TEACHING/MENTORING List trainees for whom you were the primary mentor (e.g., thesis advisor)A. UNDERGRADUATE STUDENTS e.g., Dartmouth College Arts and Sciences studentsDATES STUDENT’S NAME PROGRAM (e.g., WISP, Presidential Scholar)B. GRADUATE STUDENTS6 Name: DATES STUDENT’S NAME PROGRAM NAME DEGREEC. MEDICAL STUDENTSDATES STUDENT’S NAME PROGRAM NAME (if applicable)D. RESIDENTS/FELLOWS/RESEARCH ASSOCIATESDATES STUDENT’S NAME SPECIALTYE. FACULTYDATES MENTEE’S NAME SPECIALTYXII. COMMUNITY SERVICE, EDUCATION, AND ENGAGEMENT: 7 Name: List activities relevant to your professional rolesFor each activity, please provide the following information: a. Dates b. Institution/Organization c. Course or Activity Title d. Your Role e. Hours/YearXIII. RESEARCH FUNDING: For each funded project, please provide the following information a. Dates (start and stop) b. Project title and award number c. Your Role d. Percent Effort e. Sponsoring agency f. Annual Direct Costs of the AwardFor role, list whether you are identified as key personnel on the grant (e.g., PI, Multiple- PI, Co-I, Director, Co-Director). Do not list proposals from which you receive support if you are not identified as key personnel (i.e., NCCC core grant). If you are a co-I, list PI on the award.A. CURRENT SUPPORTB. PAST SUPPORTC. PENDING SUPPORT8 Name: XIV. PROGRAM DEVELOPMENT List any educational, clinical or research entities at Dartmouth that were created or notably advanced by your effortsXV. ENTREPRENEURIAL ACTIVITIES List any patents, licenses or other entrepreneurial activitiesXVI. MAJOR COMMITTEE ASSIGNMENTS:National/internationalDATES COMMITTEE ROLE INSTITUTION9 Name: RegionalDATES COMMITTEE ROLE INSTITUTIONInstitutionalDATES COMMITTEE ROLE INSTITUTIONXVII. MEMBERSHIPS, OFFICE AND COMMITTEE ASSIGNMENTS IN PROFESSIONAL SOCIETIES:DATES SOCIETY ROLE10 Name: XVIII. EDITORIAL BOARDS:DATES SOCIETY/JOURNAL ROLE XIX. JOURNAL REFEREE ACTIVITY:DATES JOURNAL NAMEXX. AWARDS AND HONORS:DATE AWARDXXI. INVITED PRESENTATIONS:11 Name: Indicate with an asterisk (*) those presentations to which you, individually, were extended an invitation to presentIndicate with a hashtag (#) those presentations that were meetings where you may have presented a poster/talk, but not following a personalized invitation (i.e., at a large society meeting).Indicate with a carat (^) if the talk/presentation was applicable as a CME activity.For each meeting, please provide the following: a. Date b. Topic/Title c. Sponsoring Organization d. LocationA. International:International meetings should be those that are international in scope (i.e., invitees). Such meeting may be held within the U.S.B. National:C. Regional/Local:XXII. BIBLIOGRAPHY:A. Peer-reviewed publications in print or other media (Use a standard format that includes list of ALL authors, date of publication, title of publication, journal/book name, volume (number) and inclusive pages or appropriate web address).Original articles:1.12 Name: Reviews:1.Book chapters:1.B. Other scholarly work in print or other media including editorially-reviewed publications (e.g., Op-Ed pieces, Letters to the Editor), print resources (e.g., workshops) and electronic resources (e.g., MOOCs, educational websites, modules, videos, virtual patients). Include all pertinent information for each (e.g., all authors, your contribution; dates and sites) and for educational media provide names of schools/institutions in which they are utilized as well usage numbers (e.g. downloads, ‘hits’) if available.C. Abstracts: Include both oral, exhibit and poster presentations. Indicate with (#) abstracts that were reviewed (e.g., by a professional society) prior to being accepted for presentation.13 Name: XXIII. Personal Statement: Please highlight in ~1-3 pages those accomplishments that best define your contributions to the academic mission of Geisel. Include your educational, clinical and research activities, as well as your goals. Use this space to describe activities that may benefit from a more substantive description than the entries listed in your CV. Do not use this space to simply reiterate information that is listed in the CVUpdated by:Date:14

This Version Was Updated 11.17.17

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