Mentor/Mentee request form


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Please fill out the form below as thoroughly as possible.

Personal Information (* = required)
Name*:
Email address*:
Confirm email*:
Department:
Institution:
Phone number:
 
What is your status
Undergraduate student
Graduate student
Faculty
Independent scholar or other
 
Research interests:
 
Have you attended or presented at any conferences in the past?
No.
Yes, a few.
Yes, many.
 
Are you interested in being a mentor, or being a mentee?
I would like to be a mentee.
I would like to be a mentor.
 
Additional message
(any questions or comments are welcome):
 
Spam blocker: Please type
the last name of the current U.S. President.

When you click submit, your request will be sent to the mentor/mentee coordinator.