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* 1. Please provide your contact information.

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* 2. How frequently would you be interested in meeting with a new faculty member? Choose the most representative response. 

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* 3. In what ways would you be interested in serving as a mentor? Rank in order from 1 = most interested, to 6 = least interested.

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* 4. Please provide any additional information about yourself that will help us match you best.

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