Volunteer Faculty Application

Thank you for your interest in a volunteer faculty appointment with the Department of Family Medicine! We are happy to provide you with the required forms below.

Before you begin completing them, please read the following:

Applicant information letter from our Department Vice Chair, Dr. Jay Siwek. Please note: this information is only for non-Georgetown employees.


•Curriculum Vitae: You must translate your CV into this Georgetown University School of Medicine-approved format. No other format will be sufficient for your faculty application.

Letters of Support: Please email the names, addresses, titles, organizations, phone numbers, and email addresses of two appropriate individuals who can comment on your qualifications to Administrative Officer Valerie Hernandez. She will send a formal request for a letter of support to these individuals after you provide this information. These letters cannot be sent until we receive, at minimum, your CV in the appropriate format and the Track and Rank checklist (above).

Release and Verification Form: Please complete the highlighted fields ONLY. The signed form should have the address(es) of the institution(s) so we can mail it for verification. If you have the graduate school and board certificates, send those in lieu of the Verification form. Note: to expedite your appointment, please send the Release and Verification Form as soon as possible. The other required items can follow at a later date.

FA-1NU Form: Please complete the highlighted fields ONLY (i.e., just write your name, degree, signature and date). The Department completes the rest.

Teaching Portfolio: Please list your current and past teaching experience, if applicable.  

FA-7 Confidential Information Form

Verification of Employment Form: For MedStar and all other non-Georgetown affiliates (not required for Georgetown University employees). 

CAPRICORN Enrollment Form: Not required for a GU faculty appointment. Please only complete this if you are interested in working with the CAPRICORN research consortium. (For more information on CAPRICORN, please click here.)


Please contact Administrative Officer Valerie Hernandez at 202-687-1600 or vah4@georgetown.edu.


Last Modified 03.04.14