EULAR Academic Mentee Registration Form 2016

EULAR Health Professionals Standing Committee

Thank you for registering to join the EULAR academic mentorship programme. We look forward to matching you with a EULAR mentor. Please can you complete the details below so that we understand what academic skills you want to develop. We will then be able to link you with an academic mentor.

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* 1. Personal details:

Title:

First name:

Last name:

Gender

Professional background

Post title

Years of working experience

Country

Phone

Confirm email

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* 2. Please confirm you are happy for these details to be shared with a potential EULAR academic mentor:

Yes

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* 3. Mentorship Details - Please provide details of what academic skills you hope to gain through working with an academic mentor?:

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* 4. Please select the INITIAL aspect of your academic work practice for which you are seeking a mentor:

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* 5. Partner preferences (if any) - We have a data base of experienced academic mentors and will to match on as many preferences if you have these. All mentors are able to mentor in English some will also be able to mentor in other languages. Please enter the main type of mentoring sought.

Partner Preference: Gender (default):

Partner Preference: Professional background

Partner Preference: Language preference