Faculty Assignment Report Form Step 1 of 3 33% Name* First Last Semester*SpringSummerFallYear*201520162017Email* Off Book Courses As of Fall 2012 courses that are labeled “off-book” in the academic activities report (previously instructor workload) are not pulled into the effort reporting system. This is because these courses have traditionally not been considered part of the Institutional Base Salary (IBS) of the faculty member or employee. However, if you are funded wholly or partially by off-book funds, you have the option to consider these courses as contributing to your Institutional Base Salary and subsequently, your effort. If you would like to receive credit/effort in your report for these off-book courses, please indicate this below by selecting yes and enter the course information. Otherwise, select no and the off-book courses in which you are involved with will be assigned under Other Instructional Activity.Please select if you would like to receive credit for your off book courses*Yes I want to receive credit/effort for my off book coursesNo I do not want to receive credit/effort for my off book courses; I will put my credit/effort under Other Instructional Activity (next page)This information should come from your Academic Activities Report (AAR) COURSE INFORMATIONCourse NumberSection NumberContact HoursEffort PercentageOff Book (yes or no) Total Course Effort %*Please enter a number from 0 to 100. Enter Effort by Activity Please enter effort for each of the categories below:Instructional ActivityThesis & Dissertation*Committee assignments for beginning graduate students who are registered for thesis credit, or advanced graduates who are candidates for doctoral degrees and are registered for dissertation credit. Any research functions related to thesis/dissertation supervision activity should be reported as "Departmental Funded Research” or “Externally Funded Research/Other Spons Activity" as appropriate.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Other Instructional Activity*Instruction-related activities, such as the development of new approaches, revision of materials for credit courses, adaptation of audio-visual methods, and experimentation with new teaching methodologies. Also includes grading papers and assisting students for a course section of extraordinary size (200 or more students), and instructional activities of a faculty member who does not participate in classroom meetings, and therefore, has not been assigned contact hours. Examples of other activities to be reported here include: 1. Activities of Residents and Interns in the teaching of Health Science Center students. 2. Teacher Education Center activities, including activities of Direct Instructional Support organizations as defined by the Provost. Also includes distance learning activities paid from miscellaneous gifts and grants funds.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Clinical Teaching (No Registered Students)*Time spent instructing, supervising, and advising residents, interns, or post doctoral trainees who are not formally registered students.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Research/Other Sponsored ActivitiesDepartment Funded Research*Research activities that are not sponsored and, consequently, do not receive separate budgeting and accounting. This category is also used to document any other research activities that are supported by department or non-grant sources of funding. Such duties include proposal preparation, planning and conduct of research, as well as related data analysis, manuscript preparation travel and presentation of results. Also includes the preparation and publication of scholarly reviews, chapters, monographs and books, the development of new educational approaches or techniques, the creation of works of art, music, literature, etc.; the development of and/or participation in performance of plays, concerts, and individual performance, as well as other types of medically-related creative activity.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Externally Funded Research/Other Spons Activity*Separately budgeted and accounted for research: all research activities that are funded by federal, state, local government and private organizations. This includes all approved grant, contract and industry supported research activities both basic and clinical in nature; the preparation, and conduct of research, as well as related data analysis, manuscript preparation, travel, presentation of results, as well as activities involving the training of individuals in research techniques (research training), where such activities are not included in the instruction function. FTE assignment is determined by assigned percentage on each funded project, and is dependent upon roles and tasks on the project. This should be determined in consultation with the faculty member’s supervisor and the project PI. University fund codes in which this activity is recorded are 201, 209, and 214.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Project NamePeopleSoft Project Number Effort %*Please enter a number from 0 to 100.ClinicalBilled Clinical Care*Reimbursable activities, including paid clinical contracts, in a clinical environment that do not involve health science center students or house staff. Salaries in this activity may be paid from Practice Plan funds. Activities related to grants recorded in Fund 201, 209, & 214 should be recorded as, “Externally Funded Research/Other Spons Activity.”No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Unbilled Clinical Activities*Non-reimbursable public service activities in a clinical environment that do not involve Health Science Center students or house staff.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.ServiceService*Service activities that extend the professional and/or discipline-related services of individuals to the community, state or nation, but do not generate remuneration from a third party. This includes service in professional organizations and academic or professional student organizations, as well as participation in student recruitment, admissions, orientation, and remediation. The description of duties must indicate specific activities performed.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.University/College/Department Administration*Administrative and support services benefiting common or joint University / College / Departmental activities. Supervision, management, or staff activities related to the administration of a department, college, or university. This activity provides administrative support and management direction to the instructional, research and public service programs. Generally restricted to individuals with formal administrative appointments. Effort related to university, college, department committees, councils, etc., should be reflected under University Governance. This category does not include direct administrative effort related to a specific course, which should be reflected in the appropriate instruction category. Direct administrative effort related to a specific project, and funded by the sponsored research, should be reflected in the “Externally Funded Research/Other Spons Activity” category.must indicate specific activities performed.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.University Governance*Activities that provide advisory support to the general governance of the unit or the institution, such as participation on department, college or university committees and councils. Also includes special assignments such as consultation services to university offices and units.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Practice Plan Administration*Activities for the administration of the Florida Practice Plans of the Health Center including, but not limited to, the administrative and supporting services for the billing, collecting, and distribution of professional fees.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.OtherAdvising*Formal counseling with students on academic course or program selection, scheduling, and career counseling. The description of duties must include such indicators as number of students formally advised and hours designated for advising.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Auxiliary Effort*Activities related to selling products or services. This type of effort should be charged to auxiliary accounts.No EffortEnter EffortEffort %*Please enter a number from 0 to 100.Sabbatical/Leave of Absence*Annual / Sick Leave - This activity should be used when the leave taken exceeds 20 work days in the Fall or Spring semester (13 work days in the Summer semester). To determine the appropriate percentage to be reported, multiply the FTE appointed by the number of days on leave and then divide this amount by the total number of work days in the semester.Leave of Absence (Paid) - An authorized compensated leave of absence granted to the employee by the university; includes disability leave. Effort should be reported when the chair assigns the leave.Sabbatical - An authorized compensated leave of absence granted to the employee by the university; includes sabbaticals and professional development leave. Effort should be reported when the chair assigns the sabbatical.No EffortEffort %*Please enter a number from 0 to 100.