Mentorship Program Application for Graduate Student Mentees
Name:
Your answer
Are you a first-time applicant?
E-mail address:
Your answer
Gender
Your answer
Race/ethnicity
Your answer
University:
Your answer
Degree program and specialty area (e.g., Ph.D. in Clinical Psychology):
Your answer
Year in program (if currently on internship, please specify):
Your answer
Please check off one or more boxes below to indicate your research and/or clinical interests:
What are your long-term career goals and ideal work setting once you have completed your degree (you may select more than one option)?
What are your goals and what do you hope to gain from participating in this program?
Your answer
Do you have any preferences regarding a mentor (e.g., gender, racial/ethnic background, clinical interests, etc.)? If so, please explain.
Your answer
Are you willing to communicate with your mentor at least once/month?
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