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What is your home state? (Leave blank if international)
Country of Residence: (Leave blank if USA)
UM School or College of employment as of Fall 2017:
Office Name or Department of employment as of Fall 2017:
What is your position and title with the University of Michigan?
Please enter the following information about your expected 2017-2018 supervisor at the University of Michigan. We will contact them with a recognition/appreciation letter on behalf of Mentorship regarding your involvement at the end of the program cycle.
2017-2018 Supervisor's Name
Department or Unit
How did you hear of the UM Mentorship program?
Current Faculty/Staff Mentor (please include name)
Word of Mouth
Do you have any dietary restrictions, allergies or special needs of which you would like to inform us?
If applicable, what did you study as an undergraduate student?
Please provide your preferred T-Shirt size:
I consider myself a member of this/these group(s):
Native American/Alaskan Native
Prefer Not to Disclose
I identify with the following group(s):
Heterosexual or Straight
Prefer Not to Disclose
I identify as:
I would like to mentor students who are interested in these academic or professional fields (check all that apply):
Architecture + Urban Planning
Art & Design
LSA - Biological Sciences
LSA - Humanities
LSA - Physical Sciences
LSA - Social Sciences
LSA - Undeclared
Music, Theater & Dance
Natural Resources and Environment
What kinds of group activities would you be interested in attending with your group and all Mentorship participants? (check all that apply)
Attending events to learn about campus leadership and internship opportunities
Attending a U-M sporting event (Women's volleyball, Men's basketball, Hockey, etc.)
Academic and pre-professional focused workshops (helping students choose a major, learn about graduate school, prepare for course selection, find careers, etc.)
Participating in a Community Service project (on or off-campus)
Attending a music, dance or vocal performance or show in Ann Arbor put on by student groups
Social events to casually meet other Mentorship participants/U-M students in your group
What appeals to you about the Mentorship program? Why would you like to be a Faculty/Staff mentor?
What traits and/or interests would you prefer your student co-mentor (Peer Mentor) to have? You can include anything from extracurricular involvements to field of study to affiliation group, or more (to make a good match). This information is confidential and will not be shared with your co-mentor.
In Mentorship, you and a peer mentor will work together to mentor a group of first-year students with a variety of extracurricular and academic interests. What do you hope to offer the students you are matched with?
Do you have any experience working with or communicating with undergraduate students outside of the classroom or mentorship? If so, please explain the nature of one such relationship. If not, what do you think are necessary qualities for communicating effectively with undergraduate students?
What areas of expertise or interests do you have that might benefit students, or aid in your potential to be a good faculty or staff mentor?
What campus opportunities, events or activities would you like to educate mentees about/help them take advantage of?
Faculty and staff mentors meet once monthly with their Communication Coordinator (Mentorship student staff) to discuss group progress, plan and attend activities based on the group's availability and communicate with students by phone or email. Would you be able to fit these meetings into your schedule?
How would you facilitate communication with your peer mentor (for example, how would you remain involved in the lives of your mentorship group for the duration of the program?)
Do you prefer to be matched in a group of other mentees who SHARE your interests or background, or who are DIFFERENT from you? Are there any schools or departments you would NOT like to have mentees from? Explain (please note that exact preferences may not be able to be met)
Is there anything else you'd like us to know about you, your interests/hobbies, or your past work with students?
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