Clinical Track Faculty
First and Last Name
*
First Name
Last Name
Email
*
example@example.com
Please indicate interest as a mentee or mentor
*
Please Select
I would like to be mentor
I would like to be a mentee
Please indicate interest in 1:1 mentorship or mentorship in a small group setting
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1:1
Small Group
Both
Department
*
Current Position
*
Number of years as an LSUHSC faculty member
*
What are your specific interests or areas of focus within the clinical track?
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What subjects or areas do specialize in teaching?
Please list all areas of service-related interests. Include any participation on university, school, department, professional, or community committees or boards
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Please list all scholarly activities included but not limited to scholarly presentations, publications, etc
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Please list any particular area(s) where mentoring would be beneficial to your career development.
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Please provide a 2-3 sentence description of your career goals
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Are you already part of a formal mentoring program? If you answered yes, please list the organization and your designated mentor.
Are there faculty that you are interested in working with and serving as your mentors?
*
Please upload a copy of your most recent CV.
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