ACLAM Mentor Registration Application

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Application to become a mentor for ACLAM's Mentoring Program.
NOTE: Once you have registered, your information will be retained indefinitely. Please contact us at aclammentor@aclam.org if you would like to change your contact information or be removed from the database.

Email *

Name (First, Last) *

Phone number *

Current title(s) and institution(s), including location *

I would like to mentor someone in (pick any that apply) *

Career Change (advising non-LAM/DACLAM vets looking for advice from a LAM/DACLAM vet)

ACLAM Board Prep (advising LAM vets looking to get advice from a boarded DACLAM vet)

Professional Development (advising DACLAM vets looking for advice from a more senior DACLAM vet)

Academic Promotion (advising LAM vets looking for advice on moving to faculty position or promotion from junior to senior faculty)

Career Paths/Opportunities- Vet Students and Pre-Vet Students

I am a senior faculty member and would be willing to serve as an external reviewer for academic promotion of another LAM vet. Your name and contact information will be held confidentially by the Mentoring Committee and will only be released with your permission to members of the promotion committee seeking reviewers.

Other:

Required

How did you qualify for ACLAM board certification? *

Participation in ACLAM-recognized residency program

Experience route (participating in lab animal medicine for 6 years or more)

I would like this mentoring relationship to last for (pick any that apply): *

1-2 meetings/phone calls (a mentee with targeted questions that could be quickly addressed)

3-6 months (a mentee who needs guidance with decisions that they plan to make in the next 3-6 months)

1 year

Long-term/indefinitely

Required

In order for our committee to match you with the right individual, please provide any information that you feel would facilitate the best possible selection. For example: your years of experience, areas of expertise, ACLAM board certification via experience or residency track , nonhuman primates, aquatics, pharma, government, military, LAM leadership, foreign graduate, ECFVG, demographics, and prior mentorship experience including but not limited to laboratory animal medicine, etc. *

Some mentees specifically request a diverse mentor. If you wish to mentor someone in this capacity, please feel free to specify the mutual trait/s with which you identify (Eg. race, gender, religion, sexual orientation, ethnicity, nationality, socioeconomic status, language, (dis)ability, age, religious commitment, political perspective, other group, or combination) or simply indicate "N/A" if this does not resonate.

A copy of your responses will be emailed to the address you provided.

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