Skip to content
Grant Aims Accelerator Mentor Sign Up Form
*
1.
First Name
(Required.)
*
2.
Last Name
(Required.)
*
3.
Are you still interested in participating in Grant Aims Accelerator as a mentor?
(Required.)
Yes
No
*
4.
What is your primary research interests? Select all that apply.
(Required.)
Neuroendocrinology and Pituitary
Pediatric Endocrinology
Steroid Hormones, Nuclear Receptors, and Coregulators
Diabetes and Glucose Metabolism
Non-Steroid Hormone Signaling
Bone and Mineral Metabolism
Tumor Biology
Cardiovasular
Endocrine-Disrupting Chemicals
Reproductive Endocrinology
Thyroid
Adrenal (Excluding Minealcorticoids)
Adipose Tissue, Appetite, and Obesity
General Endocrinology
*
5.
Describe your research track. Select all that apply.
(Required.)
Basic
Translational
Clinical
*
6.
Country
(Required.)
*
7.
Please indicate all sources of research funding you have obtained (as PI or Co-I). Select all that apply and provide details.
(Required.)
NIH
Other U.S. Federal Agency
Foundation
Industry/Clinical Trial
Internal/Institutional
Other (please specify)
*
8.
Please provide additional details regarding your funding sources. Example: list NIH Institute, agency, and mechanism. If you received funding from an industry or foundation, please list the name of the company/organization.
(Required.)
NIH Institute Name/Mechanism
Name of U.S Agency/Mechanism
Foundation Name/Program
List Company
*
9.
If interested in participating as a mentor, how many mentees are you willing to support?
(Required.)
1
2
3+
I am not participating as a mentor.
*
10.
Are you interested in developing an ongoing relationship with your mentee, including virtual meetings?
(Required.)
Yes
No