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Office of Sponsored Programs
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Office of Sponsored Programs
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Research Faculty Off-Boarding Questionnaire
Research Faculty Off-Boarding Questionnaire
Name of Faculty Member
*
First
Last
Please provide the best email address to contact you at after your departure from HSC.
*
Name of your new institution or employer.
*
Final day at HSC
*
Date Format: MM slash DD slash YYYY
MM/DD/YYYY
Current Department at UNTHSC
*
Choose a Department
BIOSTATICS & EPIDEMIOLOGY - 303300
CENTER FOR HUMAN ID - 304600
CTR F/DIVERSITY & INTN'L PROGS - 300220
FAMILY MEDICINE - 300690
HEALTH BEHAVIOR & HEALTH SYS - 303500
INCEDO - 300580
INST TRANSLATIONAL RESEARCH - 304700
INTERNAL MEDICINE-GEN - 300700
LIBRARY - 300540
LIFESTYLE HEATH SCIENCES - 300860
MEDICAL EDUCATION - 300760
MICROBIOLOGY,IMMUNOLOGY & GENE - 302800
PEDIATRICS - 300740
PHARMACEUTICAL SCIENCES - 301400
PHARMACOLOGY & NEUROSCIENCE - 302700
PHARMACOTHERAPY - 301300
PHYSICAL THERAPY - 300820
PHYSICIAN ASSISTANT STUDIES - 300840
PHYSIOLOGY AND ANATOMY - 302600
Other
Other Department
*
Will you be requesting the transfer of any awards or contracts to your new institution?
*
Yes
No
Notes
*
Do you plan to transfer any materials to your new institution (e.g. cell lines, reagents, viral vectors, animal models)?
*
Yes
No
Notes
*
Do you have any proposals for external funding currently under consideration by a sponsor?
*
Yes
No
Notes
*
Do you have active IACUC or IRB protocols?
*
Yes
No
Notes
*
Do you plan to transfer any laboratory equipment to your new institution?
*
Yes
No
Notes
*
Do you have any radioactive materials, controlled substances, or hazardous chemicals in your lab?
*
Yes
No
Notes
*
Do you plan to transfer any animals to your new institution?
*
Yes
No
Notes
*
Do you have any active IBC protocols?
*
Yes
No
Notes
*
Do you have any Radiation equipment (X-ray, LSC counter and Laser) in your lab?
*
Yes
No
Notes
*
Are there any other special concerns or needs that the Research Division should be made aware of?
*
Yes
No
Notes
*
This page was last modified on November 18, 2020
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