MSRP Faculty Registration

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Thank you for your interest in mentoring medical students through the Institute for Clinical and Translational Science (ICTS) Medical Student Research Program (MSRP). Please complete the short form below with your information and we will add you to our list of available mentors for students. Students will contact you directly via email. For any questions, please contact Brooke Piercy (piercyb@hs.uci.edu).

First and Last Name: *

Email: *

Please indicate your academic rank: *

Assistant Professor

Associate Professor

Full Professor

Research Specialist

Other:

Please select your education level (select all that apply): *

PhD

MPH

MSc

Other:

Required

Research Bio (please provide a few sentences): *

Is there any relevant information medical students should know who may be interested in working with you?
*

How many students would you like to/can mentor?
*

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