Mentor Application for American Chemical Society Toxicology Division mentoring program

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Mentor form

Name, position, and affiliation

Each mentor/mentee group will meet once a month for ~1 hour, are you able to commit to this schedule?

Yes

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Being a mentor may require some preparation prior to the meeting time, such as preparing topics to discuss with your mentee. Is this a commitment you can make?

Yes

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Please write 1-2 paragraphs describing why you would like to serve as a mentor in this program. You may want to describe what expectations you have for your mentees and how you envision this program may help develop their careers.

Suggest a topic you would like to discuss with your potential mentee

Please select the most important area you would like to focus on during meetings with your mentee:

Pursuing and navigating an industry career

Pursuing and navigating an academic career

Pursuing and navigating careers outside academia and industry

Pursuing and navigating careers as an individual from a underrepresented minority group

Pursuing a career in chemical toxicology

Please write 2-3 sentences describing your commitment to increasing STEM diversity

Is there anything you would like to tell us about yourself that could help us match you to a mentoring circle?

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