Mentee registration form

Mentee information

Name

First Name

Last Name

Email Address

Phone number

Gender

Career stage

Field of research

What are your goals for the mentoring relationship?

Information about your preferred mentor

Please provide the names and email addresses of 1-3 mentors. If you do not have anyone in mind, please complete the 'additional mentor preferences' section below.

1. Name

First Name

Last Name

1. Email

2. Name

First Name

Last Name

2. Email

3. Name

First Name

Last Name

3. Email

Additional mentor preferences

Gender

Career stage (early, mid or senior-career researcher)

Other preferences

(Please describe below. E.g., Someone close to your field of research, someone further afar, someone who can give general career advice rather than on specific topics)

Please include any considerations we should be aware of when finding you a mentor.

What would you like us to tell your prospective mentor about you when we invite then to be your mentor?

To register your interest in becoming a mentee in the AS4SAN Mentorship Program, please complete the form below:

Please note, we will endeavour to match you with someone you preference or like, but this may not be possible. We will work with you on this.

© 2014 Australasian Social and Affective Neuroscience Society