This form is only to be completed by a student-applicant's faculty mentor or prospective faculty mentor for the Summer 2024 term. Forms submitted by students will be disqualified from consideration. The form should be submitted by May 1st at 11:59pm.

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* 1. Your name

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* 2. Name of your student

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* 3. Your Department

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* 4. Job title

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* 5. Your email

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* 6. For how long and in what capacity have you known the student?

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* 7. Will the student be assisting on one of your research projects or a project they initiated and proposed themselves?

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* 8. By checking this box, I confirm that I will mentor the student listed above should they be accepted into the URC-HASS Summer Fellows Program. I understand this will require the student to enroll in a 2 unit SRP 99 contract course with me during Summer Session A10 (June 14-Aug 30) and that I can commit to at least bi-weekly meetings with the student, either in-person or over zoom.

If you have any questions about the program and requirements, please see https://hass.ugresearch.ucla.edu/scholarships/summer-fellows or reach out to urhass@college.ucla.edu

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