UPCEA UPlift Mentorship Interest Form

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Thank you for your interest in the UPCEA UPlift Mentorship Program. This is an exclusive benefit for UPCEA members. Please complete the information requested below to express your interest in the UPlift program that runs from March through April each year.

Your Name *

Your Email *

Your Institution *

Your Title *

How would you like to participate in the UPlift program?

MENTOR: I would like to be a mentor

MENTEE: I would like to be a mentee

EITHER: I would be willing to serve as either a mentor or a mentee

Clear selection

Have you participated in UPlift previously?

YES, MENTOR: I previously served as a mentor

YES, MENTEE: I previously participated as a mentee

NO: I have not participated in the program before

OTHER

Other:

Clear selection

Agreement: I understand that UPCEA will share my contact information with Mentor Collective for the purpose of mentorship. *

YES, I agree

NO, I do not agree

Other:

Submit

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