Use this form when a faculty member is participating in RR Status.
- Enter the date that the form is filled out.
- Designate the reporting period.
- Initial Application – the faculty member is not currently on RR Status but anticipates starting.
- Year 2 and Year 3 – faculty members on RR status must document their RR Status once per year.
- Mid-cycle Change – the faculty member’s salary distribution changes mid-year.
- End RR Status – the faculty member is returning to full appointment status.
- Enter the effective date (i.e., the date that salary distributions will change)
- Enter identifying information about the faculty member.
- Enter the faculty member’s current faculty appointment.
- Enter the faculty member’s monthly institutional base salary
- Enter the correct service period for the faculty appointment
Part A: Distribution of Responsibilities at Appointment Level PRIOR to RR Status
If there are more than two sources of external funding impacted by the change use Form B: Modification to Reduced Responsibility Status to document all sources impacted. Enter the total on Form B in the total line on Form A: Initial Application. Staple the forms together.
- Enter the short titles of each external source of funding impacted (e.g., Grant/Gift A).
- Enter the corresponding % effort this faculty member is being paid from each source listed. If part of the effort for a sponsored project is being contributed as cost-sharing, that %FTE should be included as part of the Institutional Scholarly Activities, and a footnote added to indicate the % FTE that is cost shared for each sponsored project where cost sharing is provided.
- Enter the corresponding monthly salary amount this faculty member is being paid for this work.
- Enter the corresponding budget number for each funding source impacted by this change.
- Enter the amount of effort (%) and paid time (salary) for any scholarly activities – grant writing, teaching and mentoring, clinical service, cost-sharing related t