ASPIRE Mentor Agreement Form

ASPIRE Mentor Agreement Form

To be completed by the ASPIRE mentor

Purpose

As an ASPIRE mentor, you will ensure that your student mentee meets important deadlines and completes their ASPIRE research this summer. This form will describe the important deadlines and your responsibilities for mentorship.

Note that submission of this form constitutes your “signature”.

For questions, please contact:

Allyson Khau

SJV PRIME F1 Coordinator

allyson.khau@ucsf.edu

AND

Robert Rodriguez, MD

Director for SJV PRIME Inquiry

robert.rodriguez@ucsf.edu

Mentor Information

Mentor First Name*

Mentor Last Name*

Mentor Email*

Mentor Title/Degree*

Mentor Department/Division*

Mentee Information

Mentee First Name*

Mentee Last Name*

ASPIRE Program Details

Program Duration*

ASPIRE is part of the SJV PRIME curriculum. For 2025, ASPIRE will run for six weeks from June 16th, 2025 - July 25th, 2025. Students may be able to continue the project part-time during the next academic year.

Confirm Program Duration

Not Agreed

ASPIRE Funding*

SJV PRIME students will receive an ASPIRE stiped of $5,000. Applications for ASPIRE (completed by the student) are due 3/3/2025. Non-SJV PRIME students must apply for funding through Summer Explore.

Confirm ASPIRE Funding

Not Agreed

IRB/CHR Approval*

Approvals for the protection of human and/or animal subjects must be received prior to the start of ASPIRE.

Confirm IRB/CHR approval

Not Agreed

Presentation, Poster and Abstract*

On the last day of ASPIRE (July 25th, 2025), all ASPIRE students will present about their summer research and other ASPIRE experiences. Presentations will take place on the morning on 7/25/25 at UCSF Fresno. We encourage all ASPIRE research mentors to attend in-person or via Zoom in support of their research mentees.

All ASPIRE learners will also have the option to present a poster at the Explore Symposium in Fall 2025. Your guidance of the results, abstract, and poster design is highly encouraged. Unfunded or extramurally-funded learners are required to participate in the Explore Symposium, if they would like the experience reflected on their MSPE.

Confirm Presentation, Poster and Abstract

Not Agreed

UCSF Profiles*

If you are a UCSF faculty member, opportunities for student scholarship (if submitted) and summaries of completed projects, will be attached to your UCSF Faculty Profile under the Student Projects section and be available for student viewing within the LabSpot database.

Confirm UCSF Profiles Listing

Not Agreed

N/A - I am not a UCSF faculty member

Mentorship Details

Supervision*

Provide a summary of your plans for training and supervision including, goals, meeting frequency, review of work, etc.

Schedule*

List any planned absences during the ASPIRE period and identify who will alternately supervise the learner. If none, N/A.

Project Details

Project Title*

Research Coordinator*

Do you have a research coordinator that should be looped into emails with questions about the student's participation in the study, IRB, or other questions that may arise?

Yes

Research Coordinator Name*

Research Coordinator Email*

Significance:*

Evaluate the significance of the proposed research to the field.

Protocol Approval:*

If CHR/IRB approval has been approved, list the governing institution and the relevant protocol number(s) for both human and/or animal subjects.

If not applicable, please write "N/A"

Signature and Submission

Add your intitials below to finalize this submission*

Send me a copy of my responses

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