Are you interested in being a Mentee?

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* 1. Are you interested in being a Mentee?

Are you interested in being a Mentor?

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* 2. Are you interested in being a Mentor?

If you are interested in being a Mentee, how many years ago did you complete:

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* 3. If you are interested in being a Mentee, how many years ago did you complete:

Please rank your top three areas of interest/expertise from the career focus areas below, for the creation  of mentoring matches and/or Affinity Groups. (RANK YOUR TOP 3 CHOICES ONLY - even though the list goes to 12)

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* 4. Please rank your top three areas of interest/expertise from the career focus areas below, for the creation  of mentoring matches and/or Affinity Groups. (RANK YOUR TOP 3 CHOICES ONLY - even though the list goes to 12)

What is your current practice setting?

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* 5. What is your current practice setting?

Please indicate your name and contact information.

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* 6. Please indicate your name and contact information.

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