Faculty Mentor Request Form

Sponsored by the Faculty Center

Please remember that the advising relationship i expected to last at least one semester in order to have a useful impact. If you desire a brief consultation to assist with a specific question, please consider the Faculty Center consultation program or the SCOTs program.

Contact Information

Name:
Department:
E-mail:
Dept Mailstop:
Office Extension:
Best time we can reach you:
Would you prefer a mentor who is:
----------------

Specific Request: (Optional)

I need to request a mentor that is from my general content area (Science, arts, media): Yes      No
----------------

General Information

Higest Degree earned and from what institution?
Have you taught previously at an institution of higher education?
If yes, at which institution did you teach?
What courses?
For how long?