This form should be submitted by the program's academic administrator only. If you are a student, please do not submit this form.

This form is required for all School of Medicine (SOM) graduate students admitted to a PhD or MS degree program. When students identify a mentor, this form is completed and submitted to Graduate Studies. If the student changes mentors, a new form must be submitted as soon as possible.

Electronic signatures via Smartsheet will auto-date the form.

All mentors must be approved members of the SOM Graduate Faculty. The individual must meet the graduate program's requirements to serve as a mentor as described in the Graduate Council By-Laws. Individual programs may have additional requirements in addition to the Graduate Council requirements.

It is each program's responsibility to ensure that the proposed mentor meets all requirements prior to submission of the Mentor Form. Completion of this form confirms your selection of the proposed mentor and the program in which you will complete degree requirements. All fields below are required.