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* 1. Demographics

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* 2. Would you be interested in being involved in an ASBTE mentoring program as a mentor, mentee, or both?

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* 3. With what would you like assistance through the mentoring program? (Rank your highest priorities)

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* 4. Do you have any experience as a mentor or mentee? (select all that apply)

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* 5. Which style(s) would you prefer for the mentoring program? (select all that apply)

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* 6. What (if any) are mentoring options available to you at your institution?

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* 7. Additional comments

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