Dear Faculty Mentor,

We respectfully request that you consider continuing to serve as a mentor in our program and allow us to include you in our database for potential mentees to contact. You will, as always, have the choice to accept or decline any request from a new mentee as you have time available, feel that you have the appropriate experience and expertise, and believe that the personal “fit” is good for you as well as for the mentee. You also retain the right to conclude a mentorship relationship when you choose.

On this survey please indicate your general availability for three different time commitment efforts. You may choose to make yourself available for one-time consultations and/or short term (< One year) and/or long term (> One year) mentoring. Again, we would like to emphasize that you always have the choice of declining to mentor when an email is sent to you and also we can remove your name from the list of potential mentors at any time should you find yourself with more than enough to do.

Thank you for your support of the Faculty Mentoring Program.

 Please feel free to submit questions to Priscilla Furth, Associate Dean for Faculty Development, paf3@georgetown.edu.  We are looking forward to hearing from you. 

* 1. Please enter your name below.

* 2. Would you be willing to continue participating in the Faculty Mentoring Program via the new GUMC Faculty Mentoring Portal?

* 3. Please indicate which type(s) of time commitments you may be able to offer as a mentor. Select all that apply.

* 4. Please indicate which type(s) of mentoring you are interested in providing. Select all that apply.

* 5. Please indicate which interest area(s) you would be willing to mentor within. Select all that apply.

* 6. If you wish please indicate here specific areas that you are most interested in mentoring about.  For example, you could indicate a specific area of clinical practice, or type of research, or specific teaching settings. Other choices could include manuscript writing or grant preparation.

Thank you for your participation!

T