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UPCEA UPlift Mentorship Interest Form
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 2026 program.
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* Indicates required question
Your Name
*
Your answer
Your Email
*
Your answer
Your Institution
*
Your answer
Your Title
*
Your answer
Would You Like to Connect via Text?
Yes
No
Clear selection
Phone Number
Your answer
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 be either a mentor or 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:
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