Mentorship Application 2017-2018

This application is to be completed in it's entirety in order to be processed as an official applicant to the program.

The PMSA Research Mentorship Program provides an opportunity for students to obtain individualized guidance from a professional. Where possible, student participants are paired with a mentor knowledgeable in a similar field of study and/or research interest. Student researchers will be expected to meet all requirements of the course outlined in the course syllabus.

Your submission of this application demonstrates your understanding that this form must be completed accurately and in its entirety by December 1, 2016 by 11:59pm. No submissions after this date will be accepted.

    STUDENT INFORMATION

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    STUDENT SELF-ASSESSMENT

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    ACADEMICS

    The counselor will be contacted for current grades.

    ATTENDANCE

    The counselor will be contacted for your current attendance record.

    DISCIPLINE

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    RESEARCH AREAS

    Please provide your top 3 areas of research. Suggestions include, but are not limited to Medical, Engineering, Legal, Criminal Justice, Nursing, etc...
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    RESEARCH CONTACT

    Please provide any information regarding research contacts you have already made.
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    RECOMMENDATIONS

    Please provide the names of the teachers listed below that will be contacted by the mentorship program facilitator to provide a recommendation for you.
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