Mentor Request Form | Department of Surgery

UNC School of Medicine

Skip to main content

Use this form if you are interested in undertaking a project. Descriptions of mentors available may be found here.

Your Name*
Title*
Year of Training
E-Mail Address*
Telephone Number*
Department Name
Specialty of Interest
Faculty You Are Interested In
Faculty Rank
Previous Experience
Are you Thinking of Taking Additional Time During Residency for Research?*
Description of Interest, Either a specific Project, Field or Career*
Deadlines You Are Aiming For?*