Mentee Application - The Bill Anderson Fund
Last Name
Your answer
Middle Initial/Other
Your answer
First Name
Your answer
Title
(if applicable)
Your answer
Sex
Race/Ethnicity
Your answer
Departmental Affiliation:
(where you are a student)
Your answer
Institutional/Organizational Affiliation:
(where you are a student)
Your answer
Level of Degree Seeking
Field in Which Degree Seeking:
Your answer
Year in Degree Prorgram:
Your answer
Date you became a BAF Fellow:
MM
/
DD
/
YYYY
Anticipated Semester to Graduate:
Anticipated Graduation Year:
Your answer
Programmatic benchmarks that you must complete as part of your degree program:
(check all that apply)
Required
Of the programmatic benchmarks you must complete, which have you completed to this point?
(check all that apply)
Required
Have you formed your thesis or dissertation committee?
Have you proposed your dissertation or thesis to your committee?
Have you scheduled a final dissertation defense?
Are you currently funded through an assistantship within your program?
Of the programmatic benchmarks you must complete, which would you like assistance with through BAF programs (including this mentor program) and workshops?
(check all that apply)
Required
Highest degree earned to this point:
(please check one)
Field in which highest degree earned to this point:
Your answer
Place of employment:
(if applicable)
Your answer
Title of position at place of employment:
(if applicable)
Your answer
Preferred contact phone number:
Your answer
Mailing Address Line 1
(street address line 1)
Your answer
Mailing Address Line 2
(street address line 2 / apartment/unit number)
Your answer
Mailing Address CITY
Your answer
Mailing Address STATE
Your answer
Mailing Address ZIP CODE
Your answer
Preferred Email Address
Your answer
Please identify the organizational settings in which you HAVE WORKED:
(check as many as apply)
Required
Please describe any positions you have held in the above organizational settings:
Your answer
Please identify the organizational settings in which you currentlly think you may WANT TO WORK upon graduation:
Please select your TOP THREE choices.
Required
Please describe the type(s) of position(s) you seek within the settings you identified above post-graduation:
Your answer
Please list any professional activities in which you have been involved (consulting, training, certifications, etc.) in the last six months:
Your answer
Please list any journal publications (including co-authorships that have been accepted or published in the last six months. This includes technical papers, government reports, published op-eds, peer review papers and other work.
Your answer
Please list conferences attended in the last three months. Please also indicate if you were an attendee or presenter.
Your answer
Please copy current curriculum vitae and/or resume:
Your answer
Please share your topical and/or issue interests related to hazards, disasters and/or emergency management.
Your answer
Describe why you want to be a Bill Anderson Fund Mentee:
Your answer
Please identify the academic areas in which you feel you already have a high degree of competency:
(please check up to 3)
Required
Please identify the academic areas in which you seek support through BAF programs and workshops (including the mentor program) to reach a high level of competency:
(please check up to 3)
Required
Please identify the professional areas in which you feel most confident:
(please check up to 3)
Required
Please identify the professional areas in which you seek support through BAF programs (including the mentor program) and workshops to reach a high level of confidence:
(please check up to 3)
Required
Please identify any other areas in which you feel you already have a high degree of competency:
(please check up to 3)
Required
Please identify any other areas in which you seek support through BAF programs (including the mentor program) and workshops to reach a high level of competency:
(please check up to 3)
Required
Please use this space to share any additional details or ideas on areas you wish to see BAF Workshops focus on:
Your answer
Indicate your understanding that the Bill Anderson Fund expects your mentor to commit a minimum of 1 hour / maximum of 2 hours per month to the mentoring relationship:
Please identify preferred forums for communication:
(please check all that apply)
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Bill Anderson Fund. Report Abuse - Terms of Service - Additional Terms