Application

Junior Scholar Seeking a Mentor

Commission on the Status of Women (AEJMC) Mentoring Project

[Note: The information you enter on this form will be shared only with the person who becomes your mentor.]Name_______________________________________________________________________

University _____________________________Research Area(s)____________________

Email_____________________________________ Telephone _________________________

Academic status:

____Doctoral student (if so, expected graduation: _____) ____ Lecturer or instructor Number of years in academia ________ Assistant ProfessorNumber of years in academia ________Associate ProfessorNumber of years in academia ________Other _________________________

Demographics (optional):

Nationality:_______________________________________

Race/ethnicity: ______________________________________

Age: ______________________________________________

Other (e.g., physical ability, sexual orientation, etc.) _____________________

What motivates you to seek a mentor? (Check all that apply)

____Strengthen my scholarship____Strengthen my teaching____Evaluate my strengths

____Strategize my job search

____Talk about tenure/promotion____ Deal with a specific situation (if so, please give us some clues as to what it is about. Discrimination? Harassment? Other?)

________________________________________Other _______________________

Attributes and experiences you seek in a mentor (Check all that apply)

____Is a strong scholar____Is a strong teacher

____Is the same race/ethnicity as I am____Is older than I am____Has the same research specialties as I do____Holds an administrative post ____Prefer a woman

____Man or woman ____Has children

____Is a sexual minority____Other preference__________________Time and other commitments you seek:

____Periodic telephone or email consultations____Review of applications, research and/or other materials

____I need more advice than periodic consultations

____Other: _______________________________________________________

Do you have someone in mind to serve as your mentor? If so, who?_______________________

Please return form by email either to Tracy Everbach, Everbach@unt.edu, or Frances Ward-Johnson, fward2@elon.edu, by October 25, 2014.