First Name *

Last Name *

Email *

Organization *

Title *

Phone *

Are you applying to be a mentor or mentee? *

Enter required value Mentor Mentee

Have you mentored before?

Yes No

Years of Experience *

What are your reasons for wanting to be mentor? *

What roles have you held that you feel would contribute to your mentee’s professional development? *

What specific skills, talents and passions do you bring to the table? *

What do you think would be an ideal pairing for you? *

What is your preferred method of communicating with your mentee? *

Select all that apply.

Email

Phone

Text

In-Person

Video Chat

Approximately how many times will you be able to meet with your mentee during the program? *

If you are unable to connect during business hours, what other days/times are you available?

Anything else you would like to add or request?

Mentor Agreement *

By completing and submitting this application, I agree to be committed to the mentoring process and program. As a mentor, I agree that:

1. Being a mentor is not only a time commitment, it is also an investment in the career development of another person. As such, it is a commitment I take seriously and without reservation.
2. If my contact schedule or skill set does not mesh with the mentee assigned to me, I will immediately notify the Mentor Program Coordinator.
3. I will make every effort to attend program events, including check-in calls.
4. The mentee’s goals are central to the success of the program. I will hold myself and my mentee accountable to these goals.
5. Confidentiality is a vital component of the mentor-mentee relationship. I will not share any sensitive information about my mentee interactions without the permission of my mentee.
6. Upon completing the program, I will complete a short survey sharing my experience as a mentor with the Mentor Program Coordinator.
7. I am a member of AACUC.

Enter required value Yes, I acknowledge and agree to the Mentor Agreement.

Years of Experience *

Have you been mentored before? *

Enter required value Yes No

What are your reasons for wanting to be mentored? *

What are your career goals? *

Please share the specific goals you have in mind when applying for this program? *

What do you think would be an ideal pairing for you? *

What is your preferred method of communicating with your mentor? *

Select all that apply.

Email

Phone

Text

In-Person

Video Chat

Approximately how many times will you be able to meet with your mentor during the program? *

If you are unable to connect during business hours, what other days/times are you available?

Anything else you would like to add or request?

Mentee Agreement *

By completing and submitting this application, I agree to be committed to the mentoring process and program. As a mentee, I agree that…

1. My supervisor approves of my participation in this program and will provide a written letter or email of endorsement prior to starting the program.
2. Working with my mentor, I will set up a contact schedule that respects our work schedules and also respects the commitment my mentor has made to my career development.
3. Using my stated goals for the year as our baseline, I will always be open and honest with my mentor.
4. I will make every effort to attend program events, including check-in calls.
5. If my contact schedule or skill set does not mesh with the mentor assigned to me, I will immediately notify the Mentor Program Coordinator.
6. Upon completing the program, I will complete a short survey sharing my experience as a mentee with the Mentor Program Coordinator.
7. I am a member of AACUC.

Enter required value Yes, I acknowledge and agree to the Mentee Agreement.