Please complete this application for the 2023-2024 Mentorship Program.

If you are a student and would like to apply as a mentee, please apply here.

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* 1. First Name

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* 2. Last Name

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* 3. Student ID (leave blank if you don't remember)

We are working hard to make our school a more diverse, inclusive, and equitable community that invests in and uplifts our diverse students, faculty, and staff. Therefore, we will be incorporating demographic questions to help with our matching process. Please only respond if you are comfortable.

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* 4. Please indicate your personal pronouns. Read more about pronouns here. Your response to this question is optional. This will be shared with your mentee.

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* 5. Do you identify as a first generation college student?

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* 6. In an effort to support our international student population, we would like to include an option to be matched with an alumni mentor that has a similar background and/or educational experience. If you are interested in being matched with an international student specifically to share your own experience as a grad student, resources, using OPT/CPT, getting employer sponsorship, etc., please indicate so below.

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* 7. Preferred Email

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* 8. Preferred Phone

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* 9. Linkedin Profile

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* 10. Where do you live?

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* 11. Which industry did you/do you work in?

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* 12. Are you retired?

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* 13. Where do you currently work? (If retired, where did you work before you retired?)

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* 14. FSPH degree

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* 15. Graduation year

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* 16. If you were in a joint degree program, please specify which program

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* 17. If you have any additional degrees please list them here:

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* 18. Have you participated in the Mentorship program before?

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