AUCCCO Mentorship/Consultation Program Application 2018
Please complete each question with as much information as you would like. You will be matched with an Outreach Colleague based upon your responses. Thank you!
Email address *
Name *
Your answer
Phone Number *
Your answer
University or College Name *
Your answer
Type of Academic Setting *
School Enrollment Size *
Current Position Title *
Your answer
Time in Current Position *
Your answer
Total amount of time working in Higher Education? *
Your answer
What do you hope to gain from the AUCCCO Mentorship/Consultation program? *
Your answer
What are some of the challenges you have faced or are currently facing within your role? *
Your answer
Please share at least one of your proudest outreach accomplishments? *
Your answer
Please share a goal you want to accomplish for the upcoming academic year in regards to outreach.
Your answer
Please select areas that you would like consultation or mentorship to focus on. (check all that apply) *
Required
If you were previously a part of mentorship and consultation, please select from the below pairing options.
12) How often would you like to be in contact by email/phone/skype a semester with your match (Mark all that apply) *
Required
Please note your preferred method(s) of contact for consistent communication with your match. Check all that apply. *
Required
A copy of your responses will be emailed to the address you provided.
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