Genetic Counseling Mentee
Name
*
First Name
Last Name
Preferred Email
*
example@example.com
Please check all race/ethnic backgrounds that apply to you:
African American / Black
American Indian / Alaskan Native
East Asian / Southeast Asian
Hawaiian / Pacific Islander
Hispanic / Latinx
Middle Eastern / North African
Mixed Ancestry
White
Non-citizen / International
Unknown
Prefer not to answer
Other
I am currently:
*
An undergraduate student
A graduate student
Employed full/part time
Taking a gap year
Other
Tell us a little bit about yourself. This could include what year in school you are, where you work, what you are doing during your gap year, what year you graduated, your hobbies/special interests, etc. Tell us what is important for us to know about you.
Back
Next
Who would you prefer to be paired with?
*
Current student
Alumni
No preference
What specialty are you most interested in?
*
Pediatric
Oncology
Prenatal
All of them or undecided
Other
What state/territory/province do you live in?
*
Do you speak any languages other than English?
No
Yes
Please specify the other languages you speak
Are you a first-generation college student or graduate student?
*
Yes
No
Back
Next
What is your preferred window of mentorship?
*
As needed
3 months
6 months
What is your preferred method of connection with your mentor?
Email
Video Conferencing
Telephone/Text
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 with a current student or alumni 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.
Submit
Should be Empty: