MIT Department of Biology: Academic Appointment Form

Appointment Forms

Request to Process an Academic Staff Appointment

This is an internal form for use of the Department of Biology only.

Questions or comments regarding this form or its appropriate use may be directed to Fran Chaput, fchaput [at] mit.edu, x8-7422.

New employees will need to complete an I-9 Employment Eligibility Verification Form (pdf) and tax forms, both the Federal W-4 (pdf) and the Massachusetts Withholding Form M-4 (pdf). These forms are also available in Headquarters.

*required fields

Appointment Info
Title
Last Name*
First Name*
Middle
MIT Address		MIT Phone
Indicate Action Requested*
Position*
If promotion or change, indicate previous Title and Department
Dates of Appointment*	from to
Percentage of Effort
With Permanent Tenure?	Yes No
Will Hold Concurrently			other appointment
Faculty Sponsor*			other

Personal Info
Home Address (for new employees only, or if changed)
Phone Number
Birthdate
Sex	Male Female
Social Security Number
Ethnic Origin
Citizenship	US Other
Visa Type		Other
Degree Type (Degree information required for new employees only)
Degree Date
Degree Institute
Veteran Status			Specially Disabled Vet:
For Postdoctoral and Research Fellows Only:
Outside foundation or agency providing support
Stipend will be paid	Through MIT Directly by the Agency
Salary/Account Info
Remarks
Annual Salary*	/yr. Please do not use commas, decimals or symbols.
Monthly Rate	/mo. Please do not use commas, decimals or symbols.
Account Info*	Account Number (specify up to five)		Percent Distribution
1.
2.
3.
4.
5.
Your Name*
Email*	(a copy of this request will be sent to this email address)