Thank you for your interest in attending the Advancing Mentoring Practices workshop at the University of California, Los Angeles. To register to attend this training, please complete this brief 10-15 minute survey.

We will begin reviewing registration request on August 1st. Space is limited to 50 participants.

This workshop is for faculty, instructor, staff, and administrators seeking (1) to examine, share, and strengthen their own mentoring practices (Day 1) and, optionally, (2) to develop the facilitation expertise needed to deliver mentor training to others (Day 2). Participation in Day 1 is a prerequisite for Day 2.

Details:
Day 1: Research Mentor Training, 9/12/18, 8:30-4: 30 pm (prerequisite for Day 2)
Day 2: Facilitator Training: 9/13/18, 8:30-4: 30 pm
Registration is free and breakfast and lunch are provided 

You will be notified a confirmation of your participation by August 17th.  If you have questions please email Diana Azurdia (dazurdia@mednet.ucla.edu)

Please provide the following information

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* 1. Please provide the following information

Title (please select only one)

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* 2. Title (please select only one)

Do you participate in a Training Grant? 

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* 3. Do you participate in a Training Grant? 

If someone referred you to this training, please list their name and institution.

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* 4. If someone referred you to this training, please list their name and institution.

Please describe any experience you have with research mentor training, either as a participant or as a facilitator.

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* 5. Please describe any experience you have with research mentor training, either as a participant or as a facilitator.

Are you personally mentoring trainees in the biomedical fields?

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* 6. Are you personally mentoring trainees in the biomedical fields?

Are you working with mentors whose trainees are in the biomedical fields?

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* 7. Are you working with mentors whose trainees are in the biomedical fields?

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