2017-18 Staff Mentor Interest Form

UC Blue Ash College Staff Mentor Interest Form

Use this form to submit your interest in participating as a mentor in the UC Blue Ash College Staff Mentoring Program. The information you provide will assist us in understanding your interest and for program logistics. If you have any questions email ucbahr@uc.edu and we will be happy to assist.
Contact Information
Name*

First NameLast Name
Department/Office*
Work Phone Number*

Area CodePhone Number
Email Address*
example@example.com
Employment Information
Current Job Title (include working title if applicable): *
How long have you worked at UC Blue Ash College? *
How long have you been in your current position? *
Have you held any previous positions at UC? *

YesNo
What positions and for how long? *
Supervisor Information

Your supervisor will receive an email notifying them of your interest and for approval. Please be sure to enter a correct email address for them.
Supervisor's Name*

First NameLast Name
Supervisor's Email*
example@example.com
Interest Information
Why are you interested in being a mentor?*
What do you feel are your strengths and areas of expertise?*
Do you already have someone in mind that you would like to serve as your mentee?*

YesNo
Name of the person you are considering*
Email for person you are considering*
Any other comments or questions
Submission and Approvals

Participation in the UC Blue Ash College Staff Mentoring program as a mentor requires that your supervisor approve of your participation. They will receive an email at the email address you provided for them in order to complete the approval process. We must receive their submission in order for you participate.

You will also receive a link you can share with them to complete the approval process. It is your responsibility to make sure approvals are received.
Should be Empty:

UC Blue Ash College Staff Mentor Interest Form

Contact Information

Employment Information

Supervisor Information

Interest Information

Submission and Approvals