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* 1. Title

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* 2. First Name

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* 3. Last Name

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* 4. Role

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* 5. University

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* 6. Email

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* 7. Will you be affiliated with your university for the next 12 months?

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* 8. Briefly describe your disciplinary area, research area and interests

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* 9. What are your professional goals for the next 12 - 24 months?

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* 10. Please indicate areas you would like mentoring in?

This information will be used to connect mentors and mentees with one another.

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* 11. Have you discussed your application to be a mentee with your university Council member?

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* 12. You can nominate up to three mentors from the DASSH mentor database.

You can See Mentor profiles here

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* 13. Is there any other information you wish to include which is relevant for connecting you to a suitable mentor?

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