Office of Student Research
Bressler, Suite M-019
655 West Baltimore Street
Baltimore, MD 21201
410 706 3026
Research Mentor Form
Faculty Information and Contact
1. Mentor Last Name
2. Mentor First Name and Middle Initial
6. Phone Number
7. Primary Affiliation
University of Maryland School of Dentistry
University of Maryland Graduate School
University of Maryland Francis King Carey School of Law
University of Maryland School of Medicine
University of Maryland School of Nursing
University of Maryland School of Pharmacy
University of Maryland School of Social Work
University of Maryland Medical Center (UMMC)
Veterans Affairs Medical Center (VAMC)
University of Maryland Baltimore County (UMBC)
University of Maryland College Park (UMCP)
National Institutes of Health (NIH)
8. Department(s) (select all that apply)
UM SOM - Anatomy and Neurobiology
UM SOM - Anesthesiology
UM SOM - Biochemistry and Molecular Biology
UM SOM - Dermatology
UM SOM - Diagnostic Radiology and Nuclear Medicine
UM SOM - Emergency Medicine
UM SOM - Epidemiology and Public Health
UM SOM - Family and Community Medicine
UM SOM - Medical and Research Technology
UM SOM - Medicine
UM SOM - Microbiology and Immunology
UM SOM - Neurology
UM SOM - Neurosurgery
UM SOM - Obstetrics, Gynecology and Reproductive Sciences
UM SOM - Ophthalmology and Visual Sciences
UM SOM - Orthopaedics
UM SOM - Otorhinolaryngology - Head and Neck Surgery
UM SOM - Pathology
UM SOM - Pediatrics
UM SOM - Pharmacology
UM SOM - Physical Therapy and Rehabilitation Science
UM SOM - Physiology
UM SOM - Psychiatry
UM SOM - Radiation Oncology
UM SOM - Surgery
UM SON - Family & Community Health
UM SON - Organizational System & Adult Health
UM SOP - Pharmaceutical Health Services Research
UM SOP - Pharmaceutical Sciences
UM SOP - Pharmacy Practice and Science
VAMC - Geriatric Research Education and Clinical Centers (GRECC)
10. Other Affiliations
11. Please indicate whether you have sufficient resources to mentor students and enable them to complete research projects.
I do not
12. For which of the following types of projects would you be willing to mentor students? (select all that apply)
Summer research project (typically 8-12 weeks)
Longer term research project
12 a. If you chose "Long term research project." Please elaborate if applicable.
13. What types of students are you willing to mentor? (select all that apply)
14. How many students could you mentor at the same time?
14a. Please elaborate, if necessary.
15. Please indicate whether you can provide stipend support for your student(s).
Yes, I can.
No, I cannot.
15a. If you can provide stipend support, how much can you provide? (indicate $ amount). Depending on the student"s education level, the stipend amount per student during a summer typically range from $2,000 to $5,500.
16. If you are willing to mentor a student, please provide a brief summary of the research projects(s) that would be available to students.
Speaking in Seminar Series
17. Would you be interested in speaking in the OSR"s summer research and educational seminar series for students in our supported and partner programs ( HP-STAR , SPORT , NORC , Rad Onc , Greenebaum- Schnaper , etc.)?
18. What topics or areas would you be willing to speak in?
Evaluating Applications and Presentations
19. Please indicate whether you are willing to evaluate the following. (select all that apply)
Student applications to research programs
Student research presentations
20. Additional Comments
Thank you for taking the time to complete this form.
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