2025 Mentor Interest Form

2025 Mentor Interest Form

Contact information

Last Name*

First Name*

Degree(s)*

Job Title

Institution/Employer*

Email*

Tell Us About Yourself

Experience in College Health*

1-3 years

4-10 years

11-20 years

21+ years

Area(s) of Practice*

Select all that apply.

Administration

Clinical Services

Health Promotion and Wellness

Mental Health

Student Affairs

Student Population*

2,500 or less

2,500-4,999

5,000-9,999

10,000-19,999

20,000 or more

Areas of Expertise*

Select the top three areas in which you feel the most comfortable mentoring.

Accreditation and Policy

Advocacy

Assessment

Clinical Care

Collaborative Environments

EHR and Technology

Improving Outcomes

Insurance

Leadership and Career Development

Mental Health

Marketing

Non-Discrimination

Operations and Finance

Outsourcing

Professional Development

SHAC

Wellness Programs/Services

Other (see next question)

Other Area

If you have expertise in an area not covered above, please specify:

Identity

Mentees frequently request a mentor with a specific identity (person of color, LGBTQ, parent, etc.), It is not required to provide this information but it is helpful when matching mentees to mentors.

Additional Information

Your Availability

Number of Sessions*

How many mentoring sessions would you like to do?

Availability*

Please indicate the times you are available on Thursday, May 29.

8:00 am - 8:40 am

8:50 am - 9:30 am

10:00 am - 10:40 am

10:50 am - 11:30 am

1:30 pm - 2:10 pm

3:00 pm - 3:40 pm

3:50 pm - 4:30 pm

I am not available at any of these times but would be willing to meet with a mentee at a another time.

Recommend a Colleague?

If you have a colleague who you think would make a good mentor, please provide their information below and we will contact them.

Recommended Mentor's Name

Recommended Mentor's Institution

Recommended Mentor's Email

Send me a copy of my responses

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