Submitting Affiliate Track Paperwork

Physicians based at the following affiliate sites are responsible for preparing the required paperwork when applying for appointment or promotion at MSSM: Atlantic Health System, Englewood, Good Samaritan Hospital Medical Center (West Islip, LI), Jersey City Medical Center, Jewish Home Life Care, Mount Kisco Medical Group, St. Joseph's Hospital.

Upon receipt of applications for appointment and/or promotion on the Affiliate Track:

  • Department Chair must review and sign paperwork

  • To indicate approval, chair must sign where indicated on the Transmittal Sheet

  • Prepare a PSM-100, append the signed Transmittal Sheet and all other documents.

  • Forward to the Appointments, Promotions and Tenure Office, Box 1605.

  • Note: Life numbers for Affiliate Track faculty will be assigned by the Appointments, Promotions and Tenure Office.