Mentoring Excellence Program Interest Form
This form is for UCI graduate students and post-doctoral scholars interested in the Mentoring Excellence Program
Full Name:
Your answer
Nickname:
Your answer
UCI ID Number
Your answer
UCI Email:
Your answer
Phone Number:
Your answer
Local Address:
Your answer
Please select one:
Academic School:
Program (Graduate Students) or Position (Postdoctoral Scholars):
Your answer
Year in your program/position:
ex. 5th
Your answer
Why are you interested in being a mentor?
Your answer
Please describe any previous mentorship experiences you have:
Experience either as a mentor or mentee.
Your answer
What skills do you wish to learn as a mentor?
Your answer
Please describe an academic challenge that you faced and how you overcame it:
Your answer
List three adjectives that best describe you:
Your answer
What kind of student would you like to mentor?
Check all that apply
Required
How did you hear about this program?
Your answer
Which series are you applying for?
Priority enrollment will be given to peer mentors associated with Graduate Division initiatives.
AGREEMENT
By checking both boxes you are confirming you have read and agree to both statements.
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