Virtual Mentorship Application

Please completely fill out the Virtual Mentorship application. Any partially filled-out applications will not be saved, and you cannot return to a partially filled-out application.

If there are any questions or difficulty, please send an email to info@asnr.com


 


First Name: *
(Maximum characters: 100)
You have characters left.
Last Name: *
(Maximum characters: 100)
You have characters left.
Email Address: *
Question 1a: What career stage are you in? *
Question 1b: What is the type of research you do? *
Question 2: What area of research are you in and where are you heading research-wise? Where you are on your training timeline? (for example: I study upper limb motor recovery in cuttlefish after stroke. I plan to transition to industry to build devices. I am in my third postdoctoral year and expect to be finished next year.) *
(Maximum characters: 1000)
You have characters left.
Question 3: How many mentors do you have, and how often do you meet? *
(Maximum characters: 500)
You have characters left.
Question 4: What are your current barriers to getting more mentorship? *
(Maximum characters: 500)
You have characters left.
Question 5: What are three major questions or topics you would discuss with your virtual mentor? *
(Maximum characters: 1000)
You have characters left.
Question 6: Have you mentored anyone, either formally or informally? This could mean teaching someone on your team or in your community? *
Question 6b: If so, how did your actions influence them? *
(Maximum characters: 1000)
You have characters left.

Question 7: Do you consider yourself an underrepresented minority in STEM? If so, please check any/all that apply to you.






Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

image widget