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GBS/MSTP Faculty Affiliation Request

Thank you for your interest in faculty affiliation with Graduate Biomedical Sciences (GBS) and the Medical Scientist Training Program (MSTP). Appointment as a GBS/MSTP faculty member is for a three-year period and may be renewed.

GBS/MSTP Faculty Criteria for Appointment:

Evidence of active involvement in GBS/MSTP, including: mentoring a student, teaching courses, serving on student thesis or examination committees, judging talks or poster sessions, serving as a preceptor for a rotation student, interviewing prospective students. Similar training activities from another institution(s) or program may be cited if there is no previous GBS/MSTP involvement.
Publications or other evidence of research activity from the last three years.
Current UAB Graduate School Faculty Appointment

Faculty Information

First Name:(*)

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Last Name:(*)

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BlazerID(*)

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Email:(*)

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Degree(s):(*)

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Rank:(*)

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If other, please indicate:

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Primary Department Appointment:(*)

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Secondary Departmental Appointment:
(if applicable)

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ORCID ID:

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eRA Commons ID(*)

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Which ACHE degree best fits your area of research?(*)

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Would you like to be listed as having an active research lab?(*)

Yes

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Brief Summary of Research Area:(*)

0/75

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Theme Affiliations

Note: For those faculty requesting MSTP affiliation, the faculty member must request an affiliation with a GBS theme or another PhD department in a school other than the School of Medicine.

Primary GBS Theme Affiliation:(*)

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Secondary Affiliations(s):

If "other", indicate the departmental PhD program affiliation:
(MSTP Affiliation only)

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Faculty Participation

Have you previously mentored students?(*)

Yes

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Please describe your previous mentoring experience.(*)

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Graduate Program (GBS) Involvement:(*)

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Biosketch & Other Support:
*Current NIH Biosketch Format(*)

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Trainee Tables:
*Current NIH Data Tables Format (Table 2)(*)

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MSTP Faculty Affiliation

*Only to be completed by faculty applying for MSTP faculty consideration

Have you every mentored a MD/PhD student at UAB or another institution?

Yes

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If yes, please list their name(s):

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MD/PhD (MSTP) Involvement:

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(*)

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