SMART Research Mentor Commitment Form

PI Mentor Name:*
PI Title:
PI E-Mail*
Phone#*
Department:*
Have you previously mentored a SMART program student*
How many personnel are in your laboratory?
Post-docs
Grad Students
Technicians
Other
Summer Project Title and Description: (This information is needed to recruit the best student for your project)*
Bench Mentor Name *
Bench Mentor Title*
Bench Mentor Email*
Check all relevant areas of research for the specified summer research project:*

BiochemistryBioinformaticsBlood/Hematology ResearchCancerCancer Health DisparitiesCardiovascular ScienceCell BiologyClinical StudyComputational BiologyDevelopmental BiologyDrug TherapyEpidemiologyGene TherapyHuman MicrobiomeImmunologyInfection DiseaseMicrobiologyMolecular BiologyMolecular GeneticsMolecular PathobiologyNeuroscienceNutritionPharmacologyPediatricsPhysiologyPulmonary ResearchStructural BiologyTranslational BiologyVirologyOther

Please indicate whether you desire the skills below to be previously acquired and/or if the skills will be utilized during the project:

	Previous Skills Required	Will take a student without this skill
General Laboratory Skills
Statistics
Electrophoresis
Microscopy (specify type below)
Molecular Biology (specify type below)
Cell or Tissue Culture
Animal care and Surgery
Radioisotope handling
Computational biology (specify type below)
Other (specify below)

Please specify skills listed above (i.e. Microscopy, molecular biology, computational biology) and/or include additional skills that would help us place a student in your lab:
Will you accept a student without the requested skills:
The official program duration is nine (9) weeks from June 3 - August 2. The number of students accepted is determined by the level of faculty support and program grants. Full funding for a student requires $5,400.00 salary and approximately $432.00 fringe benefits and is subject to change.
I would like to host a SMART student in my laboratory if the program is*

in-person only
Are you able to fund a student for the SMART Program?*

YesNo, but I do wish to participate as a mentor.Maybe***Due to Success Factors we must have all commitment forms by March 1, 2024.
Is your summer undergraduate research project related to the following training grants that support SMART students

NHLBI-Heart, lung and blood related researchCPRIT-Cancer related researchCNRC- Childrens Nutrition
If maybe, contact me by this date for confirmation on funding.

MonthDayYear

If you are able to fund a student, please provide the following information.
Your Department Administrator:*
Your Administrator's E-mail:*
Business Area
Cost Center/WBS:
How many student's would you like to fund?
Have you independently selected a student to fund?

YesNo
If so, what is the student's name?
NOTE* All students participating in the SMART Program must apply before the deadline of Jan. 10, 2023 and have their application reviewed and selected by the SMART Program Steering Committee in order to participate in the program.
Are you willing to consider someone else if this student is not selected by the committee to participate in SMART?

We appreciate your interest in mentoring an undergraduate student. We will be in touch with you sometime between January and March if we find a good match.
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