Mentorship Program Application for Graduate Student Mentors
Name
Your answer
Are you a first-time applicant?
E-mail address
Your answer
Gender
Your answer
Race/ethnicity
Your answer
Stage in career (e.g., year in grad school, first-year professional, etc.):
Your answer
University:
Your answer
Degree Program and Specialty Area (e.g., Ph.D. in Clinical Psychology):
Your answer
Research/Clinical Interests (e.g., autism, juvenile justice):
Your answer
Do you have any other preferences regarding a mentee (e.g., gender, racial/ethnic background, clinical interests, etc.)? If so, please explain.
Your answer
Are you willing to communicate with your mentee at least once per month?
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