Affiliate Track Instructions and Forms

Physicians who are employed in hospitals or other institutions affiliated with the Mount Sinai Health System can be granted Affiliate Track faculty appointments in the Icahn School of Medicine provided they have a role in teaching programs and/or clinical collaborations within the Mount Sinai Health System. Appointment is contingent upon approval by the President/Chief Officer of the applicant’s home institution, and subsequent approval by the School’s Board of Trustees.

These Affiliations include

  • Bronx-Lebanon Hospital Center
  • The Brooklyn Hospital Center
  • CareMount Medical
  • Good Samaritan Hospital Medical Center
  • Jupiter Medical Center
  • New Jewish Home
  • The Valley Hospital

Send completed applications (via e-mail or fax) to the Appointments, Promotions and Tenure Office.

Required Paperwork

Junior Faculty

Senior Faculty

Transmittal Sheet

Please complete all items.

Attach the copy bearing the Affiliate President’s original signature to the appointment packet submitted to the department chair at Mount Sinai.

Please complete all items.

Attach the copy bearing the affiliate president’s original signature to the appointment packet submitted to the department chair at Mount Sinai.

Chief of Service Statement Instructions

The chief of service at affiliate hospital must prepare and sign a statement recommending each candidate for appointment or promotion.

  1. Statement should not exceed one page in length for junior faculty
  2. Specify candidate’s proposed rank and department
  3. Briefly describe area of expertise/accomplishments
  4. Briefly describe candidate’s responsibilities at the affiliate hospital and as a faculty member

The nominating chief of service at the affiliate hospital must prepare and sign a statement recommending each candidate for appointment or promotion.

The statement should not exceed two pages.

The statement must specify candidate's proposed rank and department, and must include the candidate’s qualifications for appointment at that rank.

Curriculum Vitae (CV)
(Required Format)

All appointment and promotion applications must include an updated copy of candidate’s CV.

All appointment and promotion applications must include an updated copy of candidate’s CV.

Affidavit and Acknowledgment of Policies

Submit for new appointments only. Candidate must print name and sign and date both the top and bottom of the form.

Note: If candidate is not a United States citizen, he/she should only sign the top signature line on the form. Also, the copy bearing candidate's original signature must be forwarded with completed paperwork.

Submit for new appointments only. Candidate must print name and sign and date both the top and bottom of the form.

Note: If candidate is not a United States citizen, he/she should only sign the top signature line on form.

Also, the copy bearing candidate's original signature must be forwarded with completed paperwork.

Invention/Copyright Agreement

Standard intellectual property assignment agreement.

Standard intellectual property assignment agreement.

New Hire Data Sheet

Must be submitted with all new appointment requests.

Must be submitted with all new appointment requests.

Reviewer Nominee List

n/a

See Reviewer Nominee List Instructions below

Reprints/Supporting Scholarship Material

n/a

Clinical Professor / Research Professor—submit three reprints, or other representations of scholarly work. Should not exceed three submissions.

Clinical Associate Professor/ Research Associate Professor—this documentation not required.

Reviewer Nominee List Instructions

Letters of recommendation will be solicited by Mount Sinai for all senior candidates. Please provide a list of reviewers, using the following guidelines:

  • Reviewers should be recognized experts in the candidate's field or should be sufficiently familiar with the field to render an informed opinion
  • For each reviewer, please provide name, title, institution, phone number, and if possible email address.
  • Please do NOT include reviewers who are: members of candidate's own department; individuals with whom the candidate has collaborated (i.e., shared funding, etc.), or published with during the past three years.
  • No more than two reviewer selections from the same institution.

Clinical Associate Professor/Research Associate Professor

Please provide a minimum of eight reviewer nominees. Two reviewers may be from Mount Sinai or its affiliates. The list should include regional as well as local selections. Reviewers should hold the rank of Associate Professor, Professor, or have an equivalent stature.

Clinical Professor / Research Professor

Please provide a minimum of 10 reviewer nominees. Two reviewers may be from Mount Sinai or its affiliates. The list should encompass broad regional selections and include local reviewers as well. Reviewers should hold the Professorial rank or have an equivalent stature.