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AUCCCO Mentorship/Consultation Program Application 2017-18
Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
School *
Your answer
Type/Size of School *
Public or private, # of students
Your answer
Position/Title *
Your answer
Years in position *
Your answer
What do you hope to get out of the AUCCCO mentorship/consultation program? *
Your answer
How would you describe how supported you feel within your role as an outreach professional at your center? *
Your answer
What are some of the challenges you have faced within your role? *
Your answer
Please share some potential goals you want to accomplish for the upcoming academic year in regard to outreach. *
Your answer
Please select emphasis or focus areas that you like support on from a mentor. *
Required
12) How often would you like contact by phone/skype a semester with the other participant? (Mark all that apply) *
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