Training in Pharmacological Sciences

MENTOR RECOMMENDATION FORM

Thank you for sponsoring an applicant for a position in this training program. We ask that you provide an evaluation of the applicant as well as an overview of his / her training and mentoring plan and how it will achieve the stated goals of the training program. Both may be provided online by using the form below. Alternatively, hard copies may be mailed to:

            Amy Jackson
            Gulf Coast Consortia, MS 141
            P.O. Box 1892
            Houston, TX 77251-1892

If you have any questions or concerns about submitting a mentor recommendation, please contact Amy Jackson, amyjackson@rice.edu

Information in red is required.

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SUBMITTING THIS FORM.

By submitting this form, you acknowledge the following:

(1) Because this is an inter-institutional program, there may be a delay of up to several months between the start of a trainee's appointment and the transfer of funds to the trainee's institution. The Primary Mentor is responsible for providing interim funding for stipend and other awarded amounts to the trainee during this interim period. This interim funding should be established in a manner to accept reimbursement when fellowship funds are transferred to the trainee's institution. Because each institution has its own process for interim funding, it is the responsibility of the Primary Mentor to work within his/her institution (and with support from the Keck Center, as required) to manage this process.

(2) You agree to pay any additional benefits not covered by the training grant but required by your institution.

(3) You agree to notify the Keck Center's office at least two weeks prior to the termination of any trainee and furnish the exact date of termination via email and/or in writing. Termination paperwork, as required by the grant, must be provided in a timely manner.

(4) Significant changes in percent effort, work status, appointment, or academic standing must be communicated to the Keck Centeroffice in a timely manner.

Mentor

Last Name

First Name

Middle

Primary Email address

Institution

If another institution:

Academic title

Department

Address 1

Address 2

City

State

Zip

Attention

Telephone number

Fax number

Web Page URL

Please consult your departmental administrators concerning available appropriate options before completing the section below:

Type of Mentorship:
Applicant's Last Name	First Name	Middle
Desired Start Date
Fellowship Type

Applicant evaluation

Please evaluate the applicant's overall ability and likelihood of becoming a productive first quality researcher in this field.
Please include a brief statement about your relationship with the applicant, and how long you have known him/her.

Please comment on the following specific points if you feel comfortable doing so.

1) Does the applicant appear to have a career plan consistent with his/her stage of development? Does it appear realistic, and does the applicant have the ability to achieve it?

2) Please comment on the quality of the applicant's publications, abstracts, or other research presentations and describe the applicant's role in these.

3) Does the applicant have the written and oral presentations skills to communicate effectively in academics, research and professional settings? To work effectively within an interdisciplinary group ? To work with non-technical audiences and groups?

4) How would you rate the applicant's overall academic and intellectual ability including GPA, difiiculty of prior academic work and any recognition received. Has the applicant had to overcome any unusual barriers or difficulties in his/her prior training?

5) How would you rate the applicant's creativity and ability to assilimilate information from a variety of disciplines? Does the applicant have the ability and desire to synthesize new interdisciplinary ideas and concepts?

6) How would you rate the applicant, relative to other trainees you have known at comparable stages of development, in terms of overall potential for an interdisciplinary research career?

Top 1% Top 5% Top 10% Top 25% Top 50% Lower 50%

Provide Current Research Support Information

Primary Mentors must provide current support information.

NIH-supported predoctoral fellows receive the NIH scale stipend from our fellowships. This sum may not be supplemented by federal funds. Actual costs for self only or family health insurance may be covered.
The primary mentor is obligated to furnish any additional support to bring an appointed fellow up to the base level of predoctoral stipend set for that institution.
NIH-supported postdoctoral fellows receive NIH scale stipends based on years of postdoctoral experience. This sum may not be supplemented by federal funds. Actual costs for self only or family health insurance may be covered.

For each grant, provide funding agency, project title, grant number, the total award period and direct costs PER YEAR.

Mentoring Plan (max. 400 words)

Mentoring and Training Plan

Please provide a copy of the plan you and the applicant have jointly developed. Add any additional comments you feel will be beneficial to the reviewers.

The Mentoring and Training Plan should describe how the applicant's training will prepare the applicant to achieve his/her career goals. Please include anticipated didactic course work, anticipated research training, enrichment activities and personal development (e.g. writing and speaking skills), professional meetings to be attended, etc. We are particularly interested in specifics regarding how you and your trainee's co-mentor plan to collaborate. Describe how you expect this to work. Include an estimated timeline for completion of the graduate or postdoctoral training program and specific milestones to be achieved.

used words (max. 400 words)

Department Administrator Contacted

Please enter the department administrator contact information for the Primary Mentor.

First Name		Last Name
Email Address		Phone

Training Programs Home || Back to GCC Home

Gulf Coast Consortia, Rice University, MS 141, 6100 Main Street, Houston, TX 77005, phone 713-348-4752