2018 Mentor-Connect Mentorship Application: Part 1 of 2
Application Deadline: Friday, October 13, 2017
Notification of Selection: Friday, November 10, 2017

Please review instructions for this application thoroughly prior to filling it out. Proceed with this portion of the application.

Each college may submit only one application.

Mentor-Connect applications are scored by a rubric. The rubric includes factors such as demographic and geographic diversity of faculty and/ the college, discipline area, demonstrated industry need, good balance of teaching experience and faculty information. Overall interest in technician education.

Email address *
*
Your answer
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Your answer
Target Discipline of Proposed Project *
Is your college officially classified as one of the following types of institution? *
If your college can be classified as having an underserved or diverse population, but is not listed above, please describe the population.
Your answer
Is this the first application your college has submitted to Mentor-Connect? *
If no, when did you apply?
Your answer
Faculty (PI) Profile #1
Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Gender *
Race *
Ethnicity *
Faculty classification/Title *
Your answer
Name of college or other academic institution *
Your answer
Your College Department *
Your answer
Your Primary Teaching Discipline *
Your answer
Academic Degrees or Equivalent Credentials (e.g., Professional Engineer License) *
Your answer
Employment Status *
Based on your typical teaching contract (s), what is your anticipated teaching schedule for the 2017-2018 academic year? *
How many total years teaching experience do you have? *
How many years have you taught at your current academic institution? *
Faculty Personal Statement of Interest (maximum 150 words): Explain why you wish to participate in this activity and how you perceive it may benefit your college, students, and your professional and leadership development. *
Your answer
Faculty (Co-PI) Profile #2
Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Gender *
Race *
Ethnicity *
Faculty classification/ Title *
Your answer
Name of college or other academic institution *
Your answer
Your College Department *
Your answer
Your Primary Teaching Discipline *
Your answer
Academic Degrees or Equivalent Credentials (e.g., Professional Engineer License) *
Your answer
Employment Status *
Based on your typical teaching contract (s), what is your anticipated teaching schedule for the 2017-2018 academic year? *
How many total years teaching experience do you have? *
How many years have you taught for your current academic institution? *
Faculty Personal Statement of Interest (maximum 150 words): Explain why you wish to participate in this activity and how you perceive it may benefit your college, students, and your professional and leadership development. *
Your answer
Project Concept (300 words or less): Describe the interest and need for the advanced technology/STEM program you are proposing for your institution. Describe the business, industry and/or educational need this proposed program will address, the STEM/technical fields your team will target and the challenge(s) you are likely to face. Provide a brief description of the uniqueness of your college and its students and explain why your college team is interested in this mentorship opportunity. *
Your answer
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