The Triangle Global Health Consortium is initiating a mentorship program and we are seeking your input in designing the program.  The first step in the process was to gauge interest of potential mentees, primarily local university students and young professionals, in the program.  To-date over 50 respondents have expressed interest in being mentored.  The second step, for which your input is critical, is to gauge interest and availability to participate in the program from potential mentors.  

Please respond to this survey to provide insight on your interest in becoming a mentor.

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* 1. I would be interested in serving as a mentor in the following ways:  (check all that apply)

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* 2. How much time would you be able to dedicate to your participation as a mentor:

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* 3. Years of Professional Experience:

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* 4. Degrees you received:  (for example, MPH, PhD, MD)

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* 5. Organization:

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* 6. Meeting Location Preferences (select all that apply).

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* 7. It would be valuable to me if the mentee was:

  strongly disagree disagree neither agree or disagree agree strongly agree
same gender
same discipline
similar research/professional interest
similar regional country interests

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* 8. What do you hope to gain from the mentorship experience:

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* 9. Gender

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* 10. Area of professional/research interest:  (check all that apply)

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* 11. If you are interested in being contacted with mentor opportunities, please provide your name and email below.

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