SRP-99 Faculty Participation Form

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The Student Research Program (SRP) requires that all faculty members complete a Faculty Participation Form before they can sponsor students for an SRP-99 course. SRP-99 Faculty Mentors must hold a tenure track (or similar) position. Postdoctoral scholars, graduate students, and staff researchers can supervise and work with SRP-99 students but cannot serve as the instructor of record for SRP-99 courses. SRP-99 Faculty Mentors are the official instructor of record and will submit the student's grade at the end of the quarter.

If you are interested in recruiting undergraduates and advertising a research opportunity, we encourage you to post your opportunity on the Undergraduate Research Portal on MyUCLA. If you need assistance, please email the Undergraduate Research Center – Sciences at urcsciences@college.ucla.edu.

You will receive a confirmation email from urcsciences@college.ucla.edu after you are officially registered as an SRP-99 Faculty Mentor.

Please note that this form is only valid for SRP-99 courses. For more information about upper-division tutorials (numbered 196–199), contact a Student Affairs Officer (SAO) in your home department. Upper division tutorial courses are administered by academic departments, not the Undergraduate Research Centers.

Email *

UID # (9 digits, no dashes) *

Last Name: *

First Name: *

Academic Title (Professor, Associate Professor, Assistant Professor, etc.): *

Home Department
*

If your home department was not listed above, please write it here:

Department 2 (for multiple faculty appointments)

If the department you hold an second faculty appointment in was not listed above, please write it here:

Department 3 (for multiple faculty appointments)

If the department you hold a third faculty appointment in was not listed above, please write it here:

Campus Office Phone: *

Campus Office Address (Building and Room #) *

Campus Office Address Line 1 (# and street name): *

Campus Office Address Line 2 (City, State & ZIP Code): *

Campus Office Mail Code (6 digits, no dashes)

I understand that I may sponsor a maximum of ten SRP-99 students each quarter.
*

I agree

Required

For UCLA Health faculty only (David Geffen School of Medicine, School of Dentistry, and School of Nursing): I understand that all student researchers I supervise must first receive clearance from the UCLA Health Sciences (UHS) Volunteer Office. This applies to students involved in both clinical and nonclinical research. Visit https://www.uclahealth.org/volunteer/programs/uhs-volunteer-programs for more information on how to register your students.
*

I agree

This does not apply to me because I am not a faculty member in the David Geffen School of Medicine, School of Dentistry, or School of Nursing..

A copy of your responses will be emailed to the address you provided.

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