Mentoring Program Information Form

In what area(s) would you like the assistance of a mentor?

Check all that apply:

Do you prefer a mentor from inside your department, outside your department, or one of each? (Please note we will also consult with department heads about this issue.)

Choose one below:

Please indicate any preferences you have concerning the choice of mentor(s). Are particular demographic characteristics important to you (e.g., male or female, race or ethnicity)? Do you have a specific individual in mind?

Please add any comments or information, such as your previous experience, that might influence your needs as a new faculty member:

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