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)
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Last Name: *
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Email Address: *

Question 1: What career stage are you in? *

Question 2: What is the type of research you do? *

Question 3: What area of research are you in? *
(Maximum characters: 1000)
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Question 4: What year are you on your training/academic track? *

Question 5: Approximately how many years until you make your next career transition? *

Question 6: How many mentors do you have? *

Question 6a: Please describe what aspects of your career they mentor you in (e.g. technical skills, scientific direction, personal considerations, professional growth, etc.) *
(Maximum characters: 500)
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Question 7: How often do you meet with your mentors? *
(Maximum characters: 500)
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Question 8: What are your current barriers to getting more mentorship? *
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Question 9: What are three major career development topics you would discuss with your virtual mentor? Please note that the goal of this program is NOT to guide your research direction or provide scientific advice. *
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Question 10: Have you mentored anyone, either formally or informally? This could mean teaching someone on your team or in your community, or working with a peer or someone behind you in training. *

Question 10a: If so, how did your actions influence them? *
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Question 11: Do you consider yourself an underrepresented minority in STEM? If so, please check any/all that apply to you.

Black or African American

Hispanic or Latino

American Indian or Alaska Native

Native Hawaiian and other Pacific Islander

An individual with a disability

An individual from a disadvantaged background

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