Research Mentor Form*

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

udXURXeNqMNQBHTBnVrHXw9V8T9JyHMnTQZrbttsIjkhVwAkP8TVY7YyeWdrpQ4YtM368MMHJDSCYU6ARppaABdDweCv53eUjEsYkyMK7d2Q5b2H6BpZNdyC6

Returning?

A A A

We are reaching out to identify potential research opportunities for Indiana University School of Medicine (IUSM) medical students (MS1-MS4) who are seeking meaningful research experiences. If you are currently conducting research or planning a project and are open to having medical students join your team, we invite you to complete this brief survey.

The Research Mentor Form is designed to collect information from IUSM faculty who may be interested in mentoring medical students (P1Y1 to P3Y4), including those participating in research training programs such as IMPRS (summer research), SPARC, NIDDK, and gap year research experiences.

Please complete and submit the form to be included in our centralized list of research mentors, which will be shared with students via our internal webpage.

Thank you for supporting the research training and development of our medical students.

If you have questions, please contact us at imprs@iu.edu.

Faculty First Name

Faculty Last Name

Degrees

Title

Department/Division (e.g. Internal Medicine, Neurology, Pediatrics etc)

Campus

E-mail Address

Type of Research (Check all that apply)

* must provide value

Basic/Laboratory

Translational

Clinical

Community Based

Medical Education

Health Research Outcomes

Informatics

Public Health

Other

Other Type of Research

Area of Research (Check all that apply)

* must provide value

Addiction

Allergy/Infectious Disease

Anesthesia

Autoimmune Disease

Biochemistry

Biological Imaging

Biomedical Engineering Research

Blood/Hematology

Bone Biology

Cancer Biology

Cardiovascular disease

Clinical Pharmacology

Community Health Engagement

Dermatology

Developmental Biology

Diabetes

Educational Research

Endocrinology

ENT

Gene Therapy

Genetics

Genomics/Pharmacogenetics/Pharmacogenomics

Gastroenterology/Hepatology

Global Health

Implementation Science

Medical Informatics/Bioinformatics

Microbiology/Immunology

Musculoskeletal

Neuroscience

Neurosurgery

OB/GYN

Orthopaedic

Ophthalmology

Personalized Medicine

Pediatrics Research

Pediatric Gastroenterology

Pediatric Rheumatology

Pharmacology and Toxicology

Plastic Surgery

Pulmonary Diseases

Psychiatric Disease

Radiology/Imaging Sciences

Stem Cell Biology

Surgery

Urology

Vascular Biology

Other

Other Area of Research

Project Title or General Topic Area: (e.g., "Retrospective chart review of diabetic outcomes"

Brief Description of the Project (2-3 sentences):Please include the purpose and current stage (e.g., planning, data collection, analysis, writing)

What level medical student would you prefer to mentor? (Check all that apply)

* must provide value

First Year

Second Year

Third Year

Fourth Year

No Preference

What type of training do you prefer?

What is the expected time committment for the mentee? (Check all that apply)

* must provide value

Short Term Training (2 to 10 hours a week while student in school)

Summer Research (10 to 12 weeks in the summer)

Gap Year Research ( typically May to the following April; 10-11 months)

No Preference

Anticipated Project Duration or Timeline: e.g., 3 months, ongoing, until manuscript submission

What type of project or role/responsiblities for the mentee?

* must provide value

Clinical Study

Laboratory Study

Literature Review

IRB Submission/Protocol Develpment

Data Collection/Entry/Analysis

Other

Other (Project/Roles/Responsibilities)

Would you like to have IUSM medical students (rising MS2) working/training/learning in your lab for a 10-week program in the summer?

Yes No

reset

If you are interested to mentor a medical student during the summer, do you agree to be available and/or have a co-mentor such as post-doc fellow, lab manager, resident, graduate student etc. be available for mentorship if you are away?

* must provide value

Yes No

reset

If you are interested in mentoring, how many student(s) are you able to accomodate in your lab/group/project to provide them with a valuable eductional and mentored research experience (i.e. with regular contact, mentoring, distinct project)?

* must provide value

One Two Three Four or more

reset

What type of medical students do you prefer to be matched with for the mentoring?

* must provide value

Have research experience Have some research experience Do not have any research experience No preference

reset

Do you currently have your own laboratory or clinical space for research?

Yes No

reset

What is the current number of personnel in your laboratory?

None 1 2 3 4 or more

reset

What are the positions in your laboratory? (Check all that apply)

Technicians

Postdoctoral scientists

Graduate students

Undergraduate students

Have you previously mentored IUSM medical students?

Yes No

reset

Which type of program did they student particpate?

Summer Research (i.e. IMPRS) Gap Year Program (i.e. MedSTAR) Other

If yes, indicate who (student's name) and when (year).

Expand

Please upload your CV or NIH biosketch.

Upload file

Comments/Project Description

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.