IRH Humanities Faculty Mentor Program Registration Form

Humanities Faculty Mid-Career Mentoring Program

To request a mentor please fill out this form and click "Submit" at the end.
Today's Date *

Month Day Year
Date
Full Name *

First Name Last Name
Title *
Department(s) *
Phone Number *
E-mail *
example@example.com
Website
http://
PROFESSIONAL EXPERIENCES & INTERESTS
Academic Expertise: Research interest(s) & methodology; teaching responsibilities; service role(s) *
PERSONAL EXPERIENCES & INTERESTS
If there is anything you would like us to know about your professional or personal situation or life experiences that you think might be relevant for matching you with a mentor — for example, are you a member of an underrepresented group? LGBTQ+? responsible for child, dependent or elder care? — please let us know in the box below.
MENTOR INFORMATION
What special experience, knowledge, or skills are you looking for in a mentor? *
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Humanities Faculty Mid-Career Mentoring Program