OSR Engagement - Interest Form

Office of Student ResearchBressler, Suite M-019655 West Baltimore StreetBaltimore, MD 21201410 706 3026 StudentResearch@som.umaryland.edu http://medschool.umaryland.edu/osr

Office of Student Research (OSR)
Engagement Interest Form

Please complete this interest form if you are interested in OSR activities and want to learn more about how you can engage with us (e.g. participating in and volunteer support for events, program applicant review, mentoring, judging presentations, summer seminars, speaking on student research interest panels, etc.).

Name*

First NameLast Name

E-mail*

Best Phone Number

Department and/or Program*

Group

Position and/or Title (e.g., post doc, associate professor, MS III, Coordinator)*

If you have an assistant or program coordinator we should contact, please list their information below:

Secondary Contact Name

First NameLast Name

Secondary Contact E-mail

Secondary Contact Phone Number

How did you hear about OSR's events and activities?