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Salutation

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.

How did you hear of the UM Mentorship program?

Please provide your preferred T-Shirt size:

I consider myself a member of this/these group(s):

I identify with the following group(s):

I identify as:

I would like to mentor students who are interested in these academic or professional fields (check all that apply):

What kinds of group activities would you be interested in attending with your group and all Mentorship participants? (check all that apply)