AMERICAN FEDERATION FOR AGING RESEARCH (AFAR)

55 West 39th Street, 16th floor, New York, NY 10018 (212) 703-9977

Medical Student Training in Aging Research (MSTAR) Program

2017 Home Institution Faculty Sponsor and Research Mentor Form

Thank you for agreeing to serve as a Faculty Sponsor (HIFS) and/or Research Mentor for a 2016 MSTAR applicant. This form will allow AFAR to learn more about your relationship with the applicant, and how you plan to help the applicant to further his/her career in aging research and geriatrics.

Person / Materials / Method of Submission
Applicant /
  • Application Form
/ Email PDF to
Faculty Sponsor(s) /
  • This Form
  • NIH-style biosketch
/ Email to or hard copies to the address above
Research Mentor /
  • This Form
  • NIH-style biosketch
/ Email to or hard copies to the address above

If you are the Faculty Sponsor for more than one student, this form should be personalized for each applicant. Please email the completed form in PDF format to , or send a hard copy to the address above. This form and your NIH-style biosketch MUST be sent by you or someone from your office – we will not accept them from the applicant. However, we encourage you to notify the applicant once the documents have been submitted.

Part 1

Name:

Title:

Institution:

Email Address:

Phone:

Applicant’s Name:

My role is:___ Faculty Sponsor

___ Research Mentor

___ Both Faculty Sponsor and Research Mentor

Faculty Sponsor– complete section A

Research Mentor– complete section B

Both Faculty Sponsor/Research Mentor – complete sections A and B

Part 2

Section A: Mentoring Plan (Use as much space as needed for each section.)

  1. Please describe your relationship to the applicant and reasons for recommending him/her for participation in this program. Include any demonstrated interest that the applicant has shown in geriatrics and/or aging research and why you feel he/she would be a good candidate for the MSTAR program.
  2. Please provide a brief description of the resources and facilities which will be available to the applicant.
  3. Please describe current and future plans to encourage and expand the applicant’s interest in aging research after the end of the project period.

Section B: Research Plan and Training (Use as much space as needed for each section.)

  1. Please describe plans for the applicant’s participation in didactic and clinical activities during the research period.
  2. Details of the plan for the student’s research activities during the project, including plans for communication and support during the research period (frequency of meetings with the applicant, etc.)

Part 3: Please attach a recent version of your NIH-style biosketch.