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Graduate Student & Postdoctoral Professional Mentoring Program
Mentee Application
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Required Fields:  
*Name:
   
*Phone Number:
( ) - ext.
* Email Address:
*Address Line 1:
*Address Line 2:
* City:
* State:
 Zip:
 
* University/Institution:
Degree Sought:
 MS / PhD
Field of Study:
Est. Completion Date:
Faculty Advisor :
Committee Members :
Status in Program:
Not Required
Not Completed
Completed
Course Work
MS Earned
Advanced to PhD Candidacy
Writing Dissertation
 
Would you like to be matched with a mentor who is:
In your discipline
In another discipline
No preference

 Academic
Industrial
No preference		 Male
Female
No preference
Do you have any suggestions of individuals from whom you would like to receive mentoring ?
   
When are you available to begin?
Amount of time you can contribute:
Are you interested in receiving formal training on how to be an effective mentee?
yes / no
 
Meetings could be:
In Person
By Email
Over the Phone
No preference		 Over coffee
Lunch
Dinner
No preference		 Morning
Afternoon
Evening
No preference
 
Define and Explain your concept of a good mentor/mentee relationship:
Why are you most interested in forming a mentor/mentee relationship and what do you expect will be achieved through this relationship?
 
Which of the following areas would you would most like to discuss with a mentor?
(check all that apply)
Knowledge and experience in the scientific community
Mentor's career/life pathway
Additional opportunities to be supported by members of my field
Effective approaches to challenging situations I may encounter in my career
Different ways to define success and to become successful
Methods to establish quality professional relationships
Gender/diversity issues
Objective and insightful approach to my present issues and demands
Experience in leadership positions
Balancing family and career
Methods of effective networking
Mentor's scientific research
Information regarding academic versus industrial careers
Pursuits or new initiatives that will benefit my future career
 
My mentor could help to guide my career pathway by: (check all that apply)
Assisting me in formulating a career development plan
Offering constructive feedback to my CV/résumé
Identifying job possibilities for me
Participating with me in a mock job interview
Providing point(s)-of-contact for potential job(s)
Offering ideas on how to prepare for tenure or job advancement
Reviewing/critiquing articles for journal submission
Introducing me to prominent researchers in my field of study
Other:
 
Activities with your mentor could include: (check all that apply)
Social events at professional society meetings
Technical presentations at professional society meetings
Education lectures with general scientific interest
Tours of mentor's research facilities
 
Activities with your mentor will NOT include:
Discussions about our personal lives or private issues
Meetings in private locations
Social environments such as restaurants
Other:
 
If a match cannot be found according to your prefences would you like to:
Wait until a mentor matching my preferences can be found
Be matched with the first available mentor
Speak with a Mentoring Program representative to redefine my preferences
 
Additional information you would like to provide to assist in the matching process:
   

Enter Text Below:*
   
 
After submitting this application, a member of the CMDITR Mentoring Program Team will contact you within one week to discuss the details of your situation and start the process of matching you with a mentor.