Mentor Application Form

Please fill out the below form as detailed as possible. Though the MENTOR US leadership team does their best to know their members, they don't know everyone and the more information they have, the more likely successful matches can occur.

Name *
Name
Phone
Phone
Are you a MN or PhD student? *
Are you doing a thesis or capstone project?
Research indicates that mentorship pairs are more successful when demographics are considered. Complete only what you are comfortable sharing and select the following that describe you.
It is important to me to be matched with someone in the same stream. *
It is important to me to be matched with someone in the same stream.
It is important to me to be matched with someone from a similar clinical background. *
It is important to me to be matched with someone from a similar clinical background.
It is important to me to be matched with someone in similar personal circumstances? (i.e. another parent, someone working full time, international student). *
It is important to me to be matched with someone in similar personal circumstances? (i.e. another parent, someone working full time, international student).
It is important to me to be matched with someone who has similar research interests. *
It is important to me to be matched with someone who has similar research interests.
You can submit a photo of yourself to our email: mentorus@ualberta.ca
Permission *
I give MENTOR US permission to use my biography and photo at the matching event and on the MENTOR US website

Matching is not a science and the MENTOR US team does their best to accommodate preferences and create matches that are the right fit. The program is focused on the success of its members so please let the leadership team know if a match isn’t working! We are here to support you.