Genetic Counselor Mentor
Name
*
First Name
Last Name
Preferred Email
*
example@example.com
I am currently a:
*
Second-Year Student
New GC ( < 2 years)
Experienced GC
Other
What specialty are you most interested in or currently working in?
*
Pediatric
Oncology
Prenatal
Other
Tell us a little bit about yourself. This could be what year you graduated, where you work, what program you graduated from, your hobbies/special interests, etc. Tell us what is important for us to know about you.
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Who would you prefer to be paired with?
*
1st Year GC student
Prospective GC applicant (current undergraduate student/ gap-year student)
2nd year GC student
No preference
What state/territory/province do you live in?
*
Do you speak any languages other then English?
*
No
Yes
Please specify the other languages you speak
Were you a first-generation college student or graduate student?
*
Yes
No
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What is your preferred window of mentorship?
*
over 6 months
6 months
As needed
What is your preferred method of connection with your mentee?
Email
Video Conferencing
Telephone/Text
How many mentees would you be willing to mentor at one time?
*
1
1-2
2-3
Feel free to list your Myers-Briggs Type Indicator, Enneagram Type, DiSC Personality, etc. if you know it! Many companies and institutions take personality “types” into consideration when building teams because it may help determine who will collaborate most effectively.
What do you hope to gain from a mentorship relationship within this program? Feel free to list specific goals, expectations, or what would be most important to you if you were to participate in this program.
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