III. POSTDOCTORAL FELLOWSHIP APPOINTMENT FORM
Use this form for Post-Doctoral Fellowships or other Non-Degree Fellowships only. Do not use this form for post-doctoral research associates, who are regular employees for whom the appropriate employment forms should be used.
Please note, if the fellow is not a U.S. citizen then a completed form of Statement of Citizenship and Residence for Tax Purposes (Comptroller Form UPP1001; instructions for completing this form are available from the Comptroller’s Office) must accompany the Postdoctoral Fellowship Appointment form.
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Form Field Name |
Instruction |
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ACTION |
Check the appropriate category (New Appointment, Reappointment, Stipend Change) |
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NAME |
Enter the employee’s full last and first name; the middle initial or maiden name is optional. |
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DEPARTMENT |
Enter the name of the department initiating the fellowship. In parentheses, next to the name, enter the Department Number including the two digit executive level prefix. |
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FROM / THROUGH |
Enter the begin and end dates of the funding period. |
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PER MONTH |
Enter the stipend amount that the fellow will receive per month. |
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All of the following fields must be completed for new fellowship appointments. |
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ADDRESS |
Enter a complete U.S. or foreign mailing address. |
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TELEPHONE NUMBER |
Enter a home phone number if available. |
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ADDRESS for UNIVERSITY MAIL |
Enter either the building name, room number, and box or a mailcode. On the same line, indicate where stipend checks are to be delivered, using a department number (including the two digit executive level prefix. Include a university/work phone number if available. |
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MINORITY CODE |
Check the appropriate box; required by equal opportunity laws. |
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CITIZENSHIP |
Enter one from the following list: ‘US Citizen’, ‘Resident Alien’, ‘Nonresident Alien’. If the fellow is not a U.S. citizen, (s)he must complete a Statement of Citizenship and Residence for Tax Purposes (Form UPP 1001). |
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PLACE OF BIRTH |
Enter the city and state or country of birth. |
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DATE OF BIRTH |
Enter the fellow’s date of birth in the format MM/DD/YY |
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VISA STATUS |
If the fellow is not a U.S. citizen, indicate the visa classification under which (s)he is present in the U.S. (e.g., J-1, H-1B). |
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DEPT LOCATION |
Enter the building name or street address of your department. |
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SSN |
Enter the fellow’s social security number. |
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GENDER |
Check the appropriate box. |
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MARITAL STATUS |
Check the appropriate box. |
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MEDICAL LICENSE |
If a medical license is required for the fellowship appointment, check ‘YES’; otherwise check ‘NO’. |
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PREVIOUS U of C EMPLOYMENT or FELLOWSHIP |
Enter the name of the fellow’s previous fellowship at the University of Chicago (if any) or the name of the primary department and job title if the fellow was previously employed at the University of Chicago. |
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TERMINATION DATE |
Enter the end date of the fellow’s previous fellowship or employment at the Univeristy of Chicago. |
Section on Distribution of Stipend
If you are submitting the Postdoctoral Fellowship Appointment form for a stipend change or a fellowship reappointment, show the previous distribution where indicated.
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Form Field Name |
Instruction |
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ACCOUNT NAME |
Enter the name of the account to be charged. |
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ACCOUNT NUMBER |
Enter the account number to be charged. Use 8370 as the subaccount. |
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% OF TIME |
Enter the percent of the monthly stipend to be charged to this account. |
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MONTHLY STIPEND |
Enter the monthly stipend amount. |
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BEGINNING |
Enter the beginning date that the account is to be charged. |
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THROUGH |
Enter the date on which you want the charges to stop. NOTE: You must fund the fellowship through the end date entered in the top section of this form. |
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Form Field Name |
Instruction |
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TITLE of FELLOWSHIP |
Enter the title of the fellowship. |
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DEGREES |
Starting with the most recent degree earned, provide the type of degree, the year it was granted, and the name of the granting institution. |
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RESEARCH PROGRAM |
Enter the name of the study program contemplated by the fellow. |
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SOURCE of FUNDS |
Enter the name of the source of funds from which the award is made. |
If the award provides reimbursement of expenses incident to the fellowship, then check ‘YES’ where indicated and attach an itemized list to this form.
Obtain all necessary signatures before forwarding the Postdoctoral Fellowship Appointment form to the Provost’s Office.
Five copies of the form and one copy of an appointment letter to be signed for the President or Provost are provided. The forms and letter are then to be routed and signed as follows:
· The fellow and Department Chairperson sign the form. The blue copy is retained by the Chairperson, and all other copies are sent to the Dean.
· The Dean, if (s)he approves the appointment, signs where indicated and sends all copies to the Dean of Students of the Division or School, who retains the pink copy and send three copies to the Provost’s Office.
· After the appointment form has been approved in the Provost’s Office, the letter and canary copy of the appointment form are sent to the Division to be transmitted to the fellow, the green copy is retained and the original copy of the form is sent to the Office of the Comptroller.