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  1. University of Arkansas for Medical Sciences
  2. Regional Campuses
  3. Adjunct Faculty
  4. Adjunct Appointment Process
  5. Faculty Information Form

Faculty Information Form

The information requested on this Faculty Information Form is needed for two purposes: 1) review of non-paid adjunct faculty appointments by Regional Campuses administrative directors, the chair of the Department of Family and Preventive Medicine, and the Office of Faculty Affairs; and 2) entry of educational and other data into FacFacts, the College of Medicine’s faculty database. Adjunct appointments depend on the collection of this information.
At what UAMS location are you requesting a non-paid adjunct appointment?(Required)

Faculty Profile

Degree(Required)
MM slash DD slash YYYY
Spouse/Partner Name
Preferred Mailing Address(Required)
I consent to receive text messages related to processing and renewing this non-paid adjunct appointment.(Required)
Max. file size: 15 MB.

Education

Medical Licensure

Are you licensed to practice medicine in the state of Arkansas?(Required)
Is your Arkansas Medical license currently active?(Required)

Board Certification

Are you board certified?(Required)
What is your primary board certification?(Required)

Annual Activities Description

In which of the following activities will you be participating?(Required)
Attestation of prospective adjunct faculty: Please check each box showing your agreement to the statement.(Required)
Signature(Required)
MM slash DD slash YYYY
University of Arkansas for Medical Sciences LogoUniversity of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences
Mailing Address: 4301 West Markham Street, Little Rock, AR 72205
Phone: (501) 686-7000
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