Community Faculty Interest Form

Thank you for your interest, let’s get started! Please take a few minutes to register your interest and area of expertise. Kindly note your profile will not be reviewed without including a copy of your current Curriculum Vitae (CV).

Contact Information

First Name (Required)

Last Name (Required)

Email (Required)

Business Name (Required)

Business Phone Number (Required)

Business Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Cell Phone # (optional)

Alternate Point of Contact

Alternate Point of Contact (for additional assistance, if needed) (optional)

Title (optional)

Office Phone # (optional)

Office Email Address (optional)

Interest Area

I am interested in volunteering my time to the following (please select all that apply) (Required)

Undergraduate Medical Education (UME) - Medical Students

Graduate Medical Education (GME) – Residents

Research Mentor

Admissions and Student Affairs

Are you a practicing physician?

Are you a practicing physician? (Required)

Yes

No

Physician Information

Physician Specialty or Area of Expertise (Required)

If you are a practicing physician, do you currently maintain an active professional licensure? (Required)

Yes

No

N/A

Are you board certified? (Required)

Yes

No

N/A

If you have been encouraged or inspired to apply by a member of UTRGV Staff and/or Faculty, please include their name here:

CV Upload

Please upload CV

Your interest form will be reviewed by university personnel. If you qualify, you will be contacted, via email, by a university staff member who will outline the next steps in the process. If you have any questions, please contact the SOM Operations Office: somfacappts@utrgv.edu.

Community Faculty Interest Form

Office of Faculty Affairs (School of Medicine)

Contact

Helpful Links

Campus Locations

Edinburg

Harlingen

Brownsville

Follow Us on Social Media

LIKE. FOLLOW. SUBSCRIBE.