Substance Abuse Research Center
National Institute on Drug Abuse/NIDA
Interdisciplinary Training Grant
Faculty Mentor Form
(one form is required from each mentor)
The purpose of this form is to identify faculty mentors who have agreed to work with the applicant and to
assess the adequacy of resources and support that will be available to the applicant through the mentor’s
department. It will be used to evaluate the quality of the applicant’s research program, to ensure that mentors
are willing to undertake the responsibilities, and to determine what additional resources may be needed.
Material describing the training program (which is attached here) should be given to the faculty mentor to
assist him/her in completing the assessment.
Part 1. To be completed by applicant:
Name of Applicant: __________________________________________________
Applying for:
____Pre-doctoral fellowship
____Post-doctoral fellowship
Faculty Mentors:
Name
Department/Unit
Discipline/s
Name
Department/Unit
Discipline/s
*Mentors should be different from the individuals who provide the required letters of recommendation.
A pre-doctoral applicant identifies two mentors, one mentor from our NIDA Core Faculty and the other from
the degree granting/home department who will serve as the dissertation chair. A post-doctoral applicant
identifies two UMSARC faculty mentors from different disciplines; one mentor - their primary mentor - is
part of our NIDA Core Faculty working in areas related to the trainee’s interests and/or disciplines. The
primary mentor assumes the majority of mentorship responsibilities. It is preferred that the second mentor be
selected from our NIDA Secondary Faculty, but can be selected from the UMSARC Membership list. (See
NIDA Faculty & UMSARC Membership lists).
Part ll: To be completed by faculty mentors
Each mentor should complete a copy of this form. Use additional pages if needed. Please type or write
legibly.
I have reviewed the educational and research program plan outlined by this applicant which will be submitted
as part of the application package and if s/he is awarded a traineeship, I agree to work with this applicant to
achieve the training goals as outlined in the application. My research will contribute to this applicant’s
traineeship plan in the following ways (indicate specific research projects or data bases that would be
available to the applicant):
2. Support will be available to the applicant from my unit in the following specific areas (please include a
brief description of support):
 Funded research project (attach NIH “Other Support Form” if appropriate):
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 Data base:
 Office space:
 Computer access:
 Laboratory facilities:
 Clerical support:
 Other:
3. For mentors of post doctoral fellows only: Would you be able to fund all or part of a portion of
dependent health insurance coverage for this applicant?
4. If you have worked with this individual before, please include a brief assessment of her/his strengths and
weaknesses.
5. Other comments about applicant’s outline for education and research plan:
6. I agree to serve as a co-mentor along with other mentor(s) identified above for the period of this fellowship.
_________________________
Faculty Mentor Name
_________________________
Faculty Mentor Signature
________________________
Uniqname and E-mail address
_______________________
Campus Telephone
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______________________
Campus Mail Address
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