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Mentorship Program Application - Cohort 4
Mentors can be from outside of Oregon since most of our pairs meet virtually.
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* Indicates required question
Email
*
Your email
Email (professional):
*
Your answer
Current affiliation/employer:
*
Your answer
First Name:
*
Your answer
Last Name:
*
Your answer
LinkedIn profile link:
*
Your answer
Do you want to be a mentee? (you can be both a mentor and mentee)
*
Choose
Yes, mentee
No
Do you want to be a mentor? (you can be both a mentor and mentee)
*
Choose
Yes, mentor
No
Years of relevant career experience:
*
Choose
0-2 years
3-5 years
6-9 years
+10 years
What choice(s) best describe your industry sector?
*
Academic Research / Education
Biotech
Contract Research Organization / Clinical Trials
Diagnostics
Digital Health
Healthcare Delivery / Clinical Practice
Medical Devices
Pharmaceuticals
Regulatory / Policy /Government
Venture Capital / Start ups / Consulting
HR/Administrative
Legal
Finance/Accounting
Functional areas of expertise or interest:
*
Business Development / Strategy
Clinical Operations / Trial Management
Commercial / Sales / Marketing
Data Science / Bioinformatics
Manufacturing / Supply Chain / CMC
Medical Affairs / Scientific Communications
Product Development / Lifecycle Management
Quality Assurance / Compliance
Regulatory Affairs
Research & Development (R&D)
Required
Mentors - What areas you can support:
Career Planning & Progression - Clarifying goals, exploring options, preparing for transitions or promotions.
Networking & Relationship Building - Building connections in the industry, finding advocates, and navigating communities.
Leadership & Confidence - Developing executive presence, managing up, speaking with authority, leading teams.
Strategic Thinking & Decision-Making - Improving problem-solving, prioritization, and long-term planning skills.
Navigating Impostor Syndrome & Self-Advocacy - Overcoming self-doubt, asking for what you need, and owning your expertise.
Other: Add your remarks in the next section
Mentees - What areas you want to grow in:
Career Planning & Progression - Clarifying goals, exploring options, preparing for transitions or promotions.
Networking & Relationship Building - Building connections in the industry, finding advocates, and navigating communities.
Leadership & Confidence - Developing executive presence, managing up, speaking with authority, leading teams.
Strategic Thinking & Decision-Making - Improving problem-solving, prioritization, and long-term planning skills.
Navigating Impostor Syndrome & Self-Advocacy - Overcoming self-doubt, asking for what you need, and owning your expertise.
Other: Add your remarks in the next section
Mentors only: Number of Mentees you can support:
Choose
1
2
3
None: I am applying to be a Mentee
Background Identity Information (Optional):
BIPOC (Black, Indigenous, and People of Color)
LGBTQ+
First-Generation College Graduate
Immigrant / First-Generation American / Newcomer
Parent / Caregiver
Person with a Disability
Veteran / Military-Connected
Women in STEM / Gender-Diverse in STEM
Neurodivergent
Rural / Underserved Background
I prefer not to answer
Additional information you would like us to consider (optional):
Your answer
A copy of your responses will be emailed to the address you provided.
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