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).

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Requester Information

Please fill out the following required form fields.

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Alternate Contact

Please fill out an alternate point of contact for additional assistance, if needed.

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Interest Area

Please select all areas that apply.

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

Please let us know if you are a practicing physician.

Are you a practicing physician? (Required)
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Physician Information

Please fill out the following physician information fields

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If you are a practicing physician, do you currently maintain an active professional licensure? (Required)
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Are you board certified? (Required)
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CV Upload

Please upload your CV.

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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.